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General NPI Number Information
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NPI Number | 1528057692
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Entity Type | Organization
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Legal Business Name | DOWNRIVER CANCER CENTER
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Dates
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Enumeration Date | 10/20/2005
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Last Update Date | 05/29/2013
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Provider Practice Location Address
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Address Line | 19675 ALLEN RD
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City | BROWNSTOWN TWP
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State | MI
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Zip | 48183-1021
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Country | US
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Telephone | 734-479-3311
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Fax | 734-479-8009
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Provider Business Mailing Address
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Address Line | 19675 ALLEN RD
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City | BROWNSTOWN TWP
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State | MI
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Zip | 48183-1021
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Country | US
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Telephone | 734-479-3311
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Fax | 734-479-8009
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Authorized Official
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Title or Position | GROUP PRACTICE DIR.
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Name | MRS. AMY ESPOSITO
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Credential |
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Telephone | 313-916-2803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 402608
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 065057
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License Number State | MI
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