Provider Demographics
NPI:1154419430
Name:RADIATION THERAPY ASSOCIATES PC
Entity type:Organization
Organization Name:RADIATION THERAPY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:LUTSIC
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-522-8540
Mailing Address - Street 1:6255 INKSTER RD
Mailing Address - Street 2:STE B7
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2577
Mailing Address - Country:US
Mailing Address - Phone:734-522-8540
Mailing Address - Fax:734-522-5405
Practice Address - Street 1:6255 INKSTER RD
Practice Address - Street 2:STE B7
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2577
Practice Address - Country:US
Practice Address - Phone:734-522-8540
Practice Address - Fax:734-522-5405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010082992085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1674558Medicaid
MA0M83920Medicare ID - Type UnspecifiedMEDICARE
MI1674558Medicaid