# COMMUNITY CANCER CARE SPECIALISTS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PAUL M DERDERIAN DO
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407962442
- **Authorized official:** LESLIE NOWAK (PRACTICE MANAGER)
- **Authorized official phone:** (586) 493-3435

## Contact information

- **Practice address:** 1030 HARRINGTON ST, STE 301, MOUNT CLEMENS, MI 48043-2967
- **Practice address phone:** (586) 493-3440
- **Practice address fax:** (586) 493-3455
- **Mailing address:** 1030 HARRINGTON ST, STE 301, MOUNT CLEMENS, MI 48043-2967

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | — | NULL | Yes |
| 3336C0003X | Community/Retail Pharmacy | 5101009575 | MI | — |

## Other

- **Enumeration date:** 08/22/2006
- **Last updated:** 09/11/2025