Healthcare Provider Details

I. General information

NPI: 1497864680
Provider Name (Legal Business Name): FLINT RADIATION THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 KENSINGTON AVE
FLINT MI
48503-2044
US

IV. Provider business mailing address

DEPT CH 17818
PALATINE IL
60055-0001
US

V. Phone/Fax

Practice location:
  • Phone: 810-762-8058
  • Fax:
Mailing address:
  • Phone: 810-762-8058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DONG WHAN OH
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 810-762-8058