Provider Demographics
NPI:1982785804
Name:COMPREHENSIVE BREAST CENTERS OF ANN ARBOR, P.C.
Entity Type:Organization
Organization Name:COMPREHENSIVE BREAST CENTERS OF ANN ARBOR, P.C.
Other - Org Name:COMPREHENSIVE BREAST CENTERS OF ANN ARBOR, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:THREATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-677-8200
Mailing Address - Street 1:4012 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:734-677-8200
Mailing Address - Fax:734-677-8296
Practice Address - Street 1:4012 CLARK RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105
Practice Address - Country:US
Practice Address - Phone:734-677-8200
Practice Address - Fax:734-677-8296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
MIBT0261472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M30610Medicare ID - Type Unspecified