Organization
MICHIANA HEMATOLOGY-ONCOLOGY P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BILAL ANSARI MD (CO-OWNER)
(574) 237-1328
Entity
Organization
Contact information
Practice address
5340 HOLY CROSS PKWY, MISHAWAKA, IN 46545-1470
(574) 237-1328
(574) 237-1348
Mailing address
PO BOX 746092, ATLANTA, GA 30374-6092
(574) 334-5400
(574) 237-1348
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
—
—
207RX0202X
Medical Oncology Physician
Primary
—
—
207VX0201X
Gynecologic Oncology Physician
—
—
2085R0001X
Radiation Oncology Physician
—
—
332900000X
Non-Pharmacy Dispensing Site
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100389430C
—
IN
05
—
100389430H
—
IN
05
—
100389430J
—
IN
05
—
100389430M
—
IN
01
—
1560297
NCPDP
IN
05
—
300009110
—
IN
01
—
CB52227
RRMC
IN
Enumeration date
05/27/2005
Last updated
11/15/2023
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