Healthcare Provider Details

I. General information

NPI: 1194852798
Provider Name (Legal Business Name): ONCOLOGY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22255 GREENFIELD RD STE 450
SOUTHFIELD MI
48075-3710
US

IV. Provider business mailing address

PO BOX 44047
DETROIT MI
48244-0047
US

V. Phone/Fax

Practice location:
  • Phone: 248-356-2828
  • Fax:
Mailing address:
  • Phone: 248-543-8007
  • Fax: 248-543-9005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberCV025814
License Number StateMI

VIII. Authorized Official

Name: DR. CLARENCE B VAUGHN
Title or Position: MANAGER
Credential: MD
Phone: 248-356-5734