Provider Demographics
NPI:1962114744
Name:BARBARA ANN KARMANOS CANCER HOSPITAL
Entity type:Organization
Organization Name:BARBARA ANN KARMANOS CANCER HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-576-8935
Mailing Address - Street 1:31995 NORTHWESTERN HWY
Mailing Address - Street 2:WB01RX
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1625
Mailing Address - Country:US
Mailing Address - Phone:248-538-3170
Mailing Address - Fax:248-538-3180
Practice Address - Street 1:31995 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 1.G.08
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1625
Practice Address - Country:US
Practice Address - Phone:248-538-3170
Practice Address - Fax:248-538-3180
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BARBARA ANN KARMANOS CANCER HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-23
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy