Provider Demographics
NPI:1477654028
Name:PREMIER RADIATION ONCOLOGY SERVICES, P.L.C.
Entity type:Organization
Organization Name:PREMIER RADIATION ONCOLOGY SERVICES, P.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KESTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-551-2080
Mailing Address - Street 1:3601 W 13 MILE RD
Mailing Address - Street 2:RADIATION ONCOLOGY DEPARTMENT
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6712
Mailing Address - Country:US
Mailing Address - Phone:248-551-7020
Mailing Address - Fax:248-551-0089
Practice Address - Street 1:3601 W 13 MILE RD
Practice Address - Street 2:RADIATION ONCOLOGY DEPARTMENT
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6712
Practice Address - Country:US
Practice Address - Phone:248-551-7020
Practice Address - Fax:248-551-0089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty