Healthcare Provider Details

I. General information

NPI: 1134905656
Provider Name (Legal Business Name): NOVA ONCOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2023
Last Update Date: 09/01/2023
Certification Date: 09/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43494 WOODWARD AVE
BLOOMFIELD HILLS MI
48302-5052
US

IV. Provider business mailing address

43494 WOODWARD AVE
BLOOMFIELD HILLS MI
48302-5052
US

V. Phone/Fax

Practice location:
  • Phone: 248-487-9750
  • Fax: 248-504-4207
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: RAGHAD ADDUL-KARIM
Title or Position: OWNER
Credential: MD
Phone: 810-780-4181