Healthcare Provider Details

I. General information

NPI: 1528237989
Provider Name (Legal Business Name): CANCER CARE GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 W SYCAMORE ST
KOKOMO IN
46901-5148
US

IV. Provider business mailing address

6100 W 96TH ST SUITE 125
INDIANAPOLIS IN
46278-6005
US

V. Phone/Fax

Practice location:
  • Phone: 765-456-5687
  • Fax: 715-456-5811
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 Number5004183A
License Number StateIN

VIII. Authorized Official

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