Basic Information
| Provider Information | |||||||||
| NPI: | 1740275387 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BARBARA ANN KARMANOS CANCER INSTITUTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4100 JOHN R ST | ||||||||
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| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1800527626 | ||||||||
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| Practice Location | |||||||||
| Address1: | 24601 NORTHWESTERN HWY | ||||||||
| Address2: | BILLING DEPT. | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480752473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488274580 | ||||||||
| FaxNumber: | 2488277663 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BENNETT | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3135768664 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 833501 | MI | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 08727 | 01 | MI | BLUE CROSS BLUE SHIELD MI | OTHER | 2680863 | 05 | MI | MEDICAID |