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General NPI Number Information
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NPI Number | 1386864080
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Entity Type | Organization
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Legal Business Name | CANCER & HEMATOLOGY CENTERS OF WESTERN MI, P.C.
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 710 KENMOOR AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-2302
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Country | US
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Telephone | 616-389-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 5800 FOREMOST DR SE STE 300
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-7062
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Country | US
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Telephone | 616-954-9800
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Fax | 616-954-4444
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | LISA VINCENT
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Credential |
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Telephone | 616-560-3258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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