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General NPI Number Information
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NPI Number | 1942349345
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Entity Type | Organization
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Legal Business Name | MICHIANA HEMATOLOGY-ONCOLOGY P C
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 07/03/2013
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Provider Practice Location Address
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Address Line | 500 ARCADE AVE SUITE 240
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City | ELKHART
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State | IN
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Zip | 46514-2477
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Country | US
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Telephone | 574-389-0414
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Fax | 574-389-0380
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Provider Business Mailing Address
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Address Line | 3975 WILLIAM RICHARDSON DR
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City | SOUTH BEND
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State | IN
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Zip | 46628-9800
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Country | US
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Telephone | 574-234-5123
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Fax | 574-968-8488
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAFAT H ANSARI
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Credential | M.D.
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Telephone | 574-234-5123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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