Provider Demographics
NPI:1912068453
Name:GENESEE CANCER AND BLOOD DISEASE TREATMENT CENTER PC
Entity Type:Organization
Organization Name:GENESEE CANCER AND BLOOD DISEASE TREATMENT CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RIZWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DANISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-762-8400
Mailing Address - Street 1:302 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503
Mailing Address - Country:US
Mailing Address - Phone:810-762-8400
Mailing Address - Fax:810-762-8118
Practice Address - Street 1:302 KENSINGTON AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503
Practice Address - Country:US
Practice Address - Phone:810-762-8400
Practice Address - Fax:810-762-8116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0N97770Medicare PIN
ON77070Medicare ID - Type Unspecified
ON97770Medicare ID - Type Unspecified