Healthcare Provider Details

I. General information

NPI: 1700455276
Provider Name (Legal Business Name): CANCER & HEMATOLOGY CENTERS OF WESTERN MI, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 06/21/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 MICHIGAN ST NE STE 3100
GRAND RAPIDS MI
49503-2563
US

IV. Provider business mailing address

145 MICHIGAN ST NE STE 3100
GRAND RAPIDS MI
49503-2563
US

V. Phone/Fax

Practice location:
  • Phone: 616-977-4840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY MELGAREJO
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 616-977-4850