Healthcare Provider Details

I. General information

NPI: 1295972875
Provider Name (Legal Business Name): MCLAREN OWOSSO CANCER CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2009
Last Update Date: 01/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 W KING ST
OWOSSO MI
48867-2120
US

IV. Provider business mailing address

401 S BALLENGER HWY ADMINISTRATION
FLINT MI
48532-3638
US

V. Phone/Fax

Practice location:
  • Phone: 810-342-2446
  • Fax: 810-342-2428
Mailing address:
  • Phone: 810-342-2446
  • Fax: 810-342-2428

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: MR. DONALD KOOY
Title or Position: CEO
Credential:
Phone: 810-342-2446