Organization
CENTRAL CLINIC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID O OLADELE-BANKOLE MD (OWNER)
(517) 787-8371
Entity
Organization
Contact information
Practice address
603 LANSING AVE, JACKSON, MI 49202-3209
(517) 787-8371
(517) 787-2639
Mailing address
603 LANSING AVE, JACKSON, MI 49202-3209
(517) 787-8371
(517) 787-2639
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
4301042822
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2833980
—
MI
Enumeration date
10/15/2007
Last updated
09/27/2010
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