MEDICARE: JOHNSON FAMILY CENTER FOR CANCER CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QX0203X	Radiation Oncology Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0N91580	OTHER	MI	MEDICARE

General Provider Information

NPI Number	:	1639368293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHNSON FAMILY CENTER FOR CANCER CARE

Provider Business Mailing Address
First Line	:	PO BOX 776982
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6982
Country	:	US
Telephone Number	:	800-494-5797
Fax Number	:

Provider Business Practice Location Address
First Line	:	1440 E SHERMAN BLVD
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49444-1816
Country	:	US
Telephone Number	:	231-672-2008
Fax Number	:	231-672-2009

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MICHAEL PAUL GUSHO
Credential	:
Telephone Number	:	734-398-0642

Provider Enumeration Date	:	10/19/2007
Last Update Date	:	03/05/2026

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Directions to “JOHNSON FAMILY CENTER FOR CANCER CARE ” Practice Location

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