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General NPI Number Information
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NPI Number | 1609836428
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Entity Type | Organization
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Legal Business Name | HEMATOLOGY-ONCOLOGY CENTER OF MICHIGAN
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 23832 SOUTHFIELD RD
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City | SOUTHFIELD
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State | MI
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Zip | 48075-8017
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Country | US
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Telephone | 248-557-1160
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Fax | 248-552-8289
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Provider Business Mailing Address
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Address Line | 23832 SOUTHFIELD RD
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City | SOUTHFIELD
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State | MI
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Zip | 48075-8017
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Country | US
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Telephone | 248-557-1160
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Fax | 248-552-8289
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Authorized Official
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Title or Position | M.D.
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Name | DR. ILA SHAH-REDDY
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Credential | M.D.F.A.C.P.
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Telephone | 248-557-1160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 207RH0003X
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License Number State | MI
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