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NPI Code Detail

MEDICARE: CANCER CARE GROUP, P.C.

MEDICARE: CANCER CARE GROUP, P.C.
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
12085R0001XRadiation Oncology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659491132
Entity Type Code : Organization
Provider Name (Legal Business Name) : CANCER CARE GROUP, P.C.
Provider Business Mailing Address
First Line : PO BOX 78000 DEPT 78725
Second Line :
City : DETROIT
State : MI
Zip : 48278-0725
Country : US
Telephone Number : 317-715-1800
Fax Number : 317-715-6200
Provider Business Practice Location Address
First Line : 6100 W 96TH ST STE 125
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46278-6006
Country : US
Telephone Number : 317-715-1800
Fax Number : 317-715-6200
Authorized Official
Title or Position : PRESIDENT
Name : MR. THOMAS C. DUGAN
Credential : M.D.
Telephone Number : 317-715-1800
Provider Enumeration Date : 03/30/2007
Last Update Date : 08/12/2014

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Directions to “CANCER CARE GROUP, P.C. ” Practice Location

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