Healthcare Provider Details

I. General information

NPI: 1528057692
Provider Name (Legal Business Name): DOWNRIVER CANCER CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 05/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19675 ALLEN RD
BROWNSTOWN TWP MI
48183-1021
US

IV. Provider business mailing address

19675 ALLEN RD
BROWNSTOWN TWP MI
48183-1021
US

V. Phone/Fax

Practice location:
  • Phone: 734-479-3311
  • Fax: 734-479-8009
Mailing address:
  • Phone: 734-479-3311
  • Fax: 734-479-8009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number402608
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number065057
License Number StateMI

VIII. Authorized Official

Name: MRS. AMY ESPOSITO
Title or Position: GROUP PRACTICE DIR.
Credential:
Phone: 313-916-2803