Provider Demographics
NPI:1801942453
Name:MICHIGAN HEMATOLOGY ONCOLOGY PC
Entity type:Organization
Organization Name:MICHIGAN HEMATOLOGY ONCOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FARID
Authorized Official - Middle Name:T
Authorized Official - Last Name:FATA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-844-5690
Mailing Address - Street 1:1901 STAR BATT DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-3712
Mailing Address - Country:US
Mailing Address - Phone:248-844-5690
Mailing Address - Fax:248-844-5691
Practice Address - Street 1:1901 STAR BATT DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-3712
Practice Address - Country:US
Practice Address - Phone:248-844-5690
Practice Address - Fax:248-844-5691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301082244207RH0003X
MI5101017226207RH0003X
MI5601005949363A00000X
MI68010895281041C0700X
MI68010846511041C0700X
MI4301072629207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F35662OtherBCBSM GROUP PIN
MI104732771Medicaid
MI0F39539OtherBCBSM GROUP PIN FOR SOCIAL WORKERS
MI0F39539OtherBCBSM GROUP PIN FOR SOCIAL WORKERS
MI104732771Medicaid
MI0P17390Medicare PIN