MEDICARE: DEARBORN ONCOLOGY ASSOCIATES PC

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
1	261QX0200X	Oncology Clinic/Center	040797	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1106361991	OTHER	MI	BCBS
2	1106361991	OTHER	MI	BCN
3	110F339390	OTHER	MI	BC GROUP
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	110F339390	OTHER	MI	BCN

General Provider Information

NPI Number	:	1366532590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEARBORN ONCOLOGY ASSOCIATES PC

Provider Business Mailing Address
First Line	:	233 CHESTNUT CIR
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-2105
Country	:	US
Telephone Number	:	313-574-9146
Fax Number	:	248-203-9979

Provider Business Practice Location Address
First Line	:	233 CHESTNUT CIR
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-2105
Country	:	US
Telephone Number	:	313-574-9146
Fax Number	:	248-203-9979

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOSEPH C WON
Credential	:	M.D.
Telephone Number	:	313-574-9146

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	02/25/2015

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