Healthcare Provider Details

I. General information

NPI: 1124303466
Provider Name (Legal Business Name): MICHIANA HEMATOLOGY-ONCOLOGY P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5340 HOLY CROSS PKWY
MISHAWAKA IN
46545-1470
US

IV. Provider business mailing address

3975 WILLIAM RICHARDSON DR
SOUTH BEND IN
46628-9800
US

V. Phone/Fax

Practice location:
  • Phone: 800-860-8100
  • Fax: 574-237-1328
Mailing address:
  • Phone: 800-860-8100
  • Fax: 574-237-1341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number50002882A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number50002882A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number50002882A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number50002882A
License Number StateIN

VIII. Authorized Official

Name: BILAL ANSARI
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 574-261-0794