Basic Information
| Provider Information | |||||||||
| NPI: | 1225022288 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BARBARA ANN KARMANOS CANCER INSTITUTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24601 NORTHWESTERN HWY | ||||||||
| Address2: | ATTENTION DIANE BAROKY | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480752473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488274580 | ||||||||
| FaxNumber: | 2488277663 | ||||||||
| Practice Location | |||||||||
| Address1: | 4100 JOHN R ROAD | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482011312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005276266 | ||||||||
| FaxNumber: | 2488277663 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BENNETT | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | G. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2488274580 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CFO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0206X | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology, Mammography |
No ID Information.