Healthcare Provider Details

I. General information

NPI: 1609814631
Provider Name (Legal Business Name): MACOMB HEMATOLOGY ONCOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 07/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11900 E 12 MILE RD SUITE 210
WARREN MI
48093-3400
US

IV. Provider business mailing address

1122 BALFOUR ST
GROSSE POINTE PARK MI
48230-1327
US

V. Phone/Fax

Practice location:
  • Phone: 586-558-4700
  • Fax: 586-558-4706
Mailing address:
  • Phone: 586-558-4700
  • Fax: 586-558-4706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberET040673
License Number StateMI

VIII. Authorized Official

Name: DR. EFSTATHIOS TAPAZOGLOU
Title or Position: PROVIDER
Credential: MD
Phone: 586-558-4700