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NPI Code Detail

MEDICARE: CANCER CARE GROUP, P.C.

MEDICARE: CANCER CARE GROUP, P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0001XRadiation Oncology Physician

General Provider Information

NPI Number : 1124079850
Entity Type Code : Organization
Provider Name (Legal Business Name) : CANCER CARE GROUP, P.C.
Provider Business Mailing Address
First Line : PO BOX 78000
Second Line : DEPT 78725
City : DETROIT
State : MI
Zip : 48278-0725
Country : US
Telephone Number : 317-715-1800
Fax Number : 317-715-6200
Provider Business Practice Location Address
First Line : 2400 17TH ST
Second Line :
City : COLUMBUS
State : IN
Zip : 47201-5351
Country : US
Telephone Number : 812-376-5544
Fax Number : 812-376-5930
Authorized Official
Title or Position : PRESIDENT
Name : THOMAS C. DUGAN
Credential : M.D.
Telephone Number : 317-715-1800
Provider Enumeration Date : 05/15/2006
Last Update Date : 08/12/2014

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