Basic Information
| Provider Information | |||||||||
| NPI: | 1548286990 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HURON RIVER RADIATION ONCOLOGY SPECIALISTS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 995 | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481060995 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347123596 | ||||||||
| FaxNumber: | 7347125344 | ||||||||
| Practice Location | |||||||||
| Address1: | 5301 EAST HURON RIVER DR | ||||||||
| Address2: | |||||||||
| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481970995 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347123595 | ||||||||
| FaxNumber: | 7347125344 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2006 | ||||||||
| LastUpdateDate: | 10/06/2020 | ||||||||
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| AuthorizedOfficialLastName: | NARAYAN | ||||||||
| AuthorizedOfficialFirstName: | SAMIR | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 7347123596 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 10/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.