Healthcare Provider Details

I. General information

NPI: 1467017434
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: 05/06/2019
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 FOREMOST DR SE STE 202
GRAND RAPIDS MI
49546-7062
US

IV. Provider business mailing address

5800 FOREMOST DR SE STE 300
GRAND RAPIDS MI
49546-7062
US

V. Phone/Fax

Practice location:
  • Phone: 616-389-1800
  • Fax:
Mailing address:
  • Phone: 833-850-0888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN REXFORD
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 833-850-0888