Organization
MICHIANA HEMATOLOGY-ONCOLOGY P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAFAT H. ANSARI MD (PRESIDENT)
(800) 860-8100
Entity
Organization
Contact information
Practice address
1205 S MAIN ST, SUITE 301, CROWN POINT, IN 46307-3676
(219) 661-1640
(219) 661-8066
Mailing address
3975 WILLIAM RICHARDSON DR, SOUTH BEND, IN 46628-9800
(800) 860-8100
(574) 237-1341
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
50002882A
IN
207VX0201X
Gynecologic Oncology Physician
50002882A
IN
2085R0001X
Radiation Oncology Physician
50002882A
IN
332900000X
Non-Pharmacy Dispensing Site
50002882A
IN
332B00000X
Durable Medical Equipment & Medical Supplies
50002882A
IN
Other
Enumeration date
10/19/2011
Last updated
03/19/2012
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