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General NPI Number Information
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NPI Number | 1568548147
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Entity Type | Organization
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Legal Business Name | MICHIGAN CANCER CENTER PC
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 04/20/2009
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Provider Practice Location Address
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Address Line | 28455 HAGGERTY RD SUITE #203
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City | NOVI
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State | MI
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Zip | 48377
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Country | US
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Telephone | 248-324-4444
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Fax | 248-324-2444
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Provider Business Mailing Address
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Address Line | 28455 HAGGERTY RD SUITE #203
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City | NOVI
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State | MI
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Zip | 48377
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Country | US
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Telephone | 248-324-4444
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Fax | 248-324-2444
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Authorized Official
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Title or Position | PRESIDENT
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Name | LEOPOLDO EISENBERG
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Credential | MD
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Telephone | 248-324-4444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 4301033530
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License Number State | MI
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