Healthcare Provider Details

I. General information

NPI: 1801203583
Provider Name (Legal Business Name): BARBARA ANN KARMANOS CANCER HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 JOHN R ST MAIL CODE: UH050T
DETROIT MI
48201-2013
US

IV. Provider business mailing address

4100 JOHN R ST MAIL CODE: UH050T
DETROIT MI
48201-2013
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-7094
  • Fax:
Mailing address:
  • Phone: 313-745-7094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: REGINA DOXTADER
Title or Position: CFO
Credential:
Phone: 313-576-8657