Healthcare Provider Details

I. General information

NPI: 1376553529
Provider Name (Legal Business Name): ONCOLOGIC SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 HARRINGTON ST
MOUNT CLEMENS MI
48043-2901
US

IV. Provider business mailing address

PO BOX 72239
CLEVELAND OH
44192-0002
US

V. Phone/Fax

Practice location:
  • Phone: 586-493-7510
  • Fax: 586-493-7511
Mailing address:
  • Phone: 314-991-8200
  • Fax: 314-569-1787

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: ARTHUR J FRAZIER
Title or Position: PRESIDENT
Credential: MD
Phone: 586-493-7510