=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265451868
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDICAL ONCOLOGY ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2901 STABLER ST
-----------------------------------------------------
City | LANSING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48910-3022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-669-4222
-----------------------------------------------------
Fax | 616-669-4222
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 22097
-----------------------------------------------------
City | LANSING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48909-2097
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-669-4222
-----------------------------------------------------
Fax | 517-669-4222
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ONCOLOGIST
-----------------------------------------------------
Name | SUE TOBIN
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 517-669-4222
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RX0202X
-----------------------------------------------------
Taxonomy Name | Medical Oncology Physician
-----------------------------------------------------
License Number | 5101013923
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------