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General NPI Number Information
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NPI Number | 1114028982
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Entity Type | Organization
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Legal Business Name | NORTHERN MICHIGAN HEMATOLOGY AND ONCOLOGY
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 10/06/2011
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Provider Practice Location Address
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Address Line | 560 W MITCHELL ST SUITE 185
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City | PETOSKEY
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State | MI
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Zip | 49770-2275
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Country | US
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Telephone | 231-487-3478
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Fax | 231-487-3578
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Provider Business Mailing Address
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Address Line | 560 W MITCHELL ST SUITE 185
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City | PETOSKEY
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State | MI
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Zip | 49770-2275
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Country | US
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Telephone | 231-487-3478
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Fax | 231-487-3578
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | CATHERINE M. DEVET
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Credential |
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Telephone | 231-487-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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