Healthcare Provider Details

I. General information

NPI: 1679614424
Provider Name (Legal Business Name): GRAND RAPIDS RADIATION ONCOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 CHERRY
GRAND RAPIDS MI
49503
US

IV. Provider business mailing address

6935 RELIABLE PKWY
CHICAGO IL
60686-0001
US

V. Phone/Fax

Practice location:
  • Phone: 616-752-6218
  • Fax: 616-774-8960
Mailing address:
  • Phone: 616-897-0995
  • Fax: 616-897-0986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: DR. JAMES M KANE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 616-897-0995