Healthcare Provider Details

I. General information

NPI: 1114028982
Provider Name (Legal Business Name): NORTHERN MICHIGAN HEMATOLOGY AND ONCOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 W MITCHELL ST SUITE 185
PETOSKEY MI
49770-2275
US

IV. Provider business mailing address

560 W MITCHELL ST SUITE 185
PETOSKEY MI
49770-2275
US

V. Phone/Fax

Practice location:
  • Phone: 231-487-3478
  • Fax: 231-487-3578
Mailing address:
  • Phone: 231-487-3478
  • Fax: 231-487-3578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE M. DEVET
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 231-487-4000