Basic Information
| Provider Information | |||||||||
| NPI: | 1124079850 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CANCER CARE GROUP, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 78000 | ||||||||
| Address2: | DEPT 78725 | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482780725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177151800 | ||||||||
| FaxNumber: | 3177156200 | ||||||||
| Practice Location | |||||||||
| Address1: | 2400 17TH ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472015351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123765544 | ||||||||
| FaxNumber: | 8123765930 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 08/12/2014 | ||||||||
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| AuthorizedOfficialLastName: | DUGAN | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3177151800 | ||||||||
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| 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 |
No ID Information.