Healthcare Provider Details

I. General information

NPI: 1427781186
Provider Name (Legal Business Name): BARBARA ANN KARMANOS CANCER HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2022
Last Update Date: 07/08/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 MEDICAL CENTER PKWY
MAUMEE OH
43537-1921
US

IV. Provider business mailing address

4100 JOHN R ST
DETROIT MI
48201-2013
US

V. Phone/Fax

Practice location:
  • Phone: 313-576-9182
  • Fax:
Mailing address:
  • Phone: 800-527-6266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN GAMBLE
Title or Position: CFO
Credential:
Phone: 313-576-8935