Organization
CANCER & HEMATOLOGY CENTERS OF WESTERN MI, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA VINCENT (CREDENTIALING SPECIALIST)
(616) 560-3258
Entity
Organization
Contact information
Practice address
710 KENMOOR AVE SE, GRAND RAPIDS, MI 49546-2302
(616) 389-1800
Mailing address
5800 FOREMOST DR SE STE 300, GRAND RAPIDS, MI 49546-7062
(616) 954-9800
(616) 954-4444
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23D0675313
CLIA
MI
01
—
23D0873642
CLIA
MI
01
—
23D0923923
CLIA
MI
01
—
23D0929489
CLIA
MI
01
—
23D0973254
CLIA
MI
01
—
23D1081376
CLIA
MI
01
—
23D2125912
CLIA
MI
01
—
23D2235787
CLIA
MI
01
—
23D2277833
CLIA
MI
01
—
23D2314500
CLIA
MI
Enumeration date
04/26/2007
Last updated
03/04/2026
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