Provider Demographics
NPI:1992899280
Name:MICHIGAN ONCOLOGY ASSOCIATES PLLC
Entity type:Organization
Organization Name:MICHIGAN ONCOLOGY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:V
Authorized Official - Middle Name:ELAYNE
Authorized Official - Last Name:ARTERBERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-857-6717
Mailing Address - Street 1:461 WEST HURON STREET
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341
Mailing Address - Country:US
Mailing Address - Phone:248-857-6717
Mailing Address - Fax:
Practice Address - Street 1:461 WEST HURON STREET
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341
Practice Address - Country:US
Practice Address - Phone:248-857-6717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4855780Medicaid
MI4855780Medicaid