Healthcare Provider Details

I. General information

NPI: 1205887890
Provider Name (Legal Business Name): CANCER CARE GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 S LAFOUNTAIN ST
KOKOMO IN
46902-3803
US

IV. Provider business mailing address

PO BOX 664087
INDIANAPOLIS IN
46266-4087
US

V. Phone/Fax

Practice location:
  • Phone: 765-453-8571
  • Fax: 765-864-8769
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