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Organization
MICHIANA HEMATOLOGY ONCOLOGY OF MICHIGAN, P.C.
Active
Organization
MICHIANA HEMATOLOGY ONCOLOGY OF MICHIGAN, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAFAT H ANSARI M.D. (PRESIDENT)
(574) 234-5123
Entity
Organization
Contact information
Practice address
4 LONGMEADOW DRIVE, SUITE ONE, NILES, MI 49120
(269) 683-4153
(269) 683-4154
Mailing address
100 NAVARRE PL, STE 6695, SOUTH BEND, IN 46601-1156
(574) 234-5123
(574) 237-1341
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
—
—
207VX0201X
Gynecologic Oncology Physician
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0A11038
MIBCBS
MI
Enumeration date
06/15/2005
Last updated
10/13/2009
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