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General NPI Number Information
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NPI Number | 1790856565
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Entity Type | Organization
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Legal Business Name | MICHIGAN ONCOLOGY HEMATOLOGY, PLLC
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1030 HARRINGTON ST SUITE 103
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City | MOUNT CLEMENS
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State | MI
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Zip | 48043-2967
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Country | US
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Telephone | 586-493-3597
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Fax |
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Provider Business Mailing Address
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Address Line | 1030 HARRINGTON ST SUITE 103
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City | MOUNT CLEMENS
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State | MI
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Zip | 48043-2967
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Country | US
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Telephone | 586-493-3597
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL DAVID HENDERSON
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Credential | M.D.
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Telephone | 586-493-3597
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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 |
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License Number State |
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