Basic Information
| Provider Information | |||||||||
| NPI: | 1821048406 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIDDLETOWN CANCER CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 15040 | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477160040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124761367 | ||||||||
| FaxNumber: | 8124774153 | ||||||||
| Practice Location | |||||||||
| Address1: | 102 MCKNIGHT DR | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450444800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134242021 | ||||||||
| FaxNumber: | 5134245690 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | RAZEK | ||||||||
| AuthorizedOfficialFirstName: | ALY | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 5134242021 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MEDICAL DOCTOR | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.