Provider Demographics
NPI:1952392896
Name:CRAIG J GORDON, D.O., P.C.
Entity Type:Organization
Organization Name:CRAIG J GORDON, D.O., P.C.
Other - Org Name:CLINICAL ONCOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-522-0222
Mailing Address - Street 1:30160 ORCHARD LAKE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2254
Mailing Address - Country:US
Mailing Address - Phone:248-522-0222
Mailing Address - Fax:248-522-0225
Practice Address - Street 1:30160 ORCHARD LAKE RD STE 100
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2254
Practice Address - Country:US
Practice Address - Phone:248-522-0222
Practice Address - Fax:248-522-0225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISS065453207RH0003X
MICG008584207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOF37505OtherBCBS
MI5679150OtherAETNA
MIP6078OtherBCN
MIP88665OtherBCN
MI3404140Medicaid