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General NPI Number Information
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NPI Number | 1851561773
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Entity Type | Organization
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Legal Business Name | NORTHERN ONCOLOGY SERVICES PLLC
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Dates
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Enumeration Date | 03/06/2008
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Last Update Date | 06/11/2012
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Provider Practice Location Address
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Address Line | 515 MICHIGAN ST NE SUITE 301
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-5721
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Country | US
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Telephone | 616-456-8115
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Fax | 616-456-1079
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Provider Business Mailing Address
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Address Line | 515 MICHIGAN ST NE SUITE 301
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-5721
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Country | US
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Telephone | 616-456-8115
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Fax | 616-456-1079
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAWRENCE E PAWL
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Credential | M.D.
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Telephone | 616-456-8115
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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 | 4301038152
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License Number State | MI
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