Healthcare Provider Details

I. General information

NPI: 1649390055
Provider Name (Legal Business Name): CANCER CARE GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 08/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 N LINCOLN ST
GREENSBURG IN
47240-1327
US

IV. Provider business mailing address

PO BOX 78000 DEPT 78725
DETROIT MI
48278-0725
US

V. Phone/Fax

Practice location:
  • Phone: 812-663-1301
  • Fax: 812-663-1354
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: MR. THOMAS C. DUGAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 317-715-1800