Healthcare Provider Details

I. General information

NPI: 1639368293
Provider Name (Legal Business Name): JOHNSON FAMILY CENTER FOR CANCER CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 E SHERMAN BLVD
MUSKEGON MI
49444-1816
US

IV. Provider business mailing address

PO BOX 776982
CHICAGO IL
60677-6982
US

V. Phone/Fax

Practice location:
  • Phone: 231-672-2008
  • Fax: 231-672-2009
Mailing address:
  • Phone: 800-494-5797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL PAUL GUSHO
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 734-398-0642