Organization
MICHIGAN HEMATOLOGY ONCOLOGY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FARID T FATA MD (PRESIDENT)
(248) 620-9600
Entity
Organization
Contact information
Practice address
5680 BOW POINTE DR, STE 201, CLARKSTON, MI 48346-5407
(248) 620-9600
(248) 620-9677
Mailing address
5680 BOW POINTE DR, STE 201, CLARKSTON, MI 48346-5407
(248) 620-9600
(248) 620-9677
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
FF072629
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104732771
—
MI
Enumeration date
06/03/2010
Last updated
12/16/2010
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