Basic Information
| Provider Information | |||||||||
| NPI: | 1093839060 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HESHAM E GAYAR, M.D., P.C. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | RADIATION ONCOLOGY CONSULTANTS, PC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1236 | ||||||||
| Address2: | |||||||||
| City: | GRAND BLANC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484803236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103423813 | ||||||||
| FaxNumber: | 8103423784 | ||||||||
| Practice Location | |||||||||
| Address1: | 4100 BEECHER RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103423813 | ||||||||
| FaxNumber: | 8103423784 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2007 | ||||||||
| LastUpdateDate: | 03/29/2017 | ||||||||
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| AuthorizedOfficialLastName: | GAYAR | ||||||||
| AuthorizedOfficialFirstName: | HESHAM | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8103423813 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 320B511190 | 01 | MI | BCBSM | OTHER |