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Organization

MICHIANA HEMATOLOGY-ONCOLOGY P C

Active
Organization subpart
No

Provider details

NPI number
Authorized official
BILAL ANSARI MD (PRESIDENT)
(574) 261-0794
Entity
Organization

Contact information

Practice address
5340 HOLY CROSS PKWY, MISHAWAKA, IN 46545-1470
(574) 237-1328
(574) 968-8488
Mailing address
PO BOX 746092, ATLANTA, GA 30374-6092
(574) 237-1328
(574) 237-1348

Taxonomy

Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
332900000X
Non-Pharmacy Dispensing Site
332B00000X
Durable Medical Equipment & Medical Supplies

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100389430
IN
01
1176700001
DMERC
IN
01
1560285
NCPDP
IN
01
CB5227
RRMC
IN
Enumeration date
02/05/2007
Last updated
05/14/2024
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