Provider Demographics
NPI:1902329501
Name:ACADEMIC HEMATOLOGY ONCOLOGY, PC
Entity type:Organization
Organization Name:ACADEMIC HEMATOLOGY ONCOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AYAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-KATIB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-647-3245
Mailing Address - Street 1:30700 TELEGRAPH RD STE 1536
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4590
Mailing Address - Country:US
Mailing Address - Phone:248-215-0048
Mailing Address - Fax:
Practice Address - Street 1:23850 VAN BORN RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48125-2325
Practice Address - Country:US
Practice Address - Phone:313-647-3245
Practice Address - Fax:313-577-0977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-25
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology