Provider Demographics
NPI:1104811405
Name:EAST CENTRAL ONCOLOGY ASSOCIATES
Entity type:Organization
Organization Name:EAST CENTRAL ONCOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSOCIATE
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:YAW
Authorized Official - Last Name:DANSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-631-3975
Mailing Address - Street 1:4011 ORCHARD DR
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6190
Mailing Address - Country:US
Mailing Address - Phone:989-631-3975
Mailing Address - Fax:989-631-4844
Practice Address - Street 1:4011 ORCHARD DR
Practice Address - Street 2:SUITE 1000
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6190
Practice Address - Country:US
Practice Address - Phone:989-631-3975
Practice Address - Fax:989-631-4844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079365207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4394520Medicaid
G57790Medicare UPIN
MI4394520Medicaid