Healthcare Provider Details

I. General information

NPI: 1407962442
Provider Name (Legal Business Name): COMMUNITY CANCER CARE SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 HARRINGTON ST STE 301
MOUNT CLEMENS MI
48043-2967
US

IV. Provider business mailing address

1030 HARRINGTON ST STE 301
MOUNT CLEMENS MI
48043-2967
US

V. Phone/Fax

Practice location:
  • Phone: 586-493-3440
  • Fax: 586-493-3455
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5101009575
License Number StateMI

VIII. Authorized Official

Name: LESLIE NOWAK
Title or Position: PRACTICE MANAGER
Credential:
Phone: 586-493-3435