=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225022288
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BARBARA ANN KARMANOS CANCER INSTITUTE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4100 JOHN R ROAD
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48201-1312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-527-6266
-----------------------------------------------------
Fax | 248-827-7663
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24601 NORTHWESTERN HWY ATTENTION DIANE BAROKY
-----------------------------------------------------
City | SOUTHFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48075-2473
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-827-4580
-----------------------------------------------------
Fax | 248-827-7663
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCE OFFICER
-----------------------------------------------------
Name | MR. WILLIAM G. BENNETT
-----------------------------------------------------
Credential | CFO
-----------------------------------------------------
Telephone | 248-827-4580
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0206X
-----------------------------------------------------
Taxonomy Name | Mammography Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------