Healthcare Provider Details

I. General information

NPI: 1124079850
Provider Name (Legal Business Name): CANCER CARE GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 08/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 17TH ST
COLUMBUS IN
47201-5351
US

IV. Provider business mailing address

PO BOX 78000 DEPT 78725
DETROIT MI
48278-0725
US

V. Phone/Fax

Practice location:
  • Phone: 812-376-5544
  • Fax: 812-376-5930
Mailing address:
  • Phone: 317-715-1800
  • Fax: 317-715-6200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS C. DUGAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 317-715-1800