Provider Demographics
NPI:1366532590
Name:DEARBORN ONCOLOGY ASSOCIATES PC
Entity type:Organization
Organization Name:DEARBORN ONCOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:WON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-574-9146
Mailing Address - Street 1:233 CHESTNUT CIR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-2105
Mailing Address - Country:US
Mailing Address - Phone:313-574-9146
Mailing Address - Fax:248-203-9979
Practice Address - Street 1:233 CHESTNUT CIR
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-2105
Practice Address - Country:US
Practice Address - Phone:313-574-9146
Practice Address - Fax:248-203-9979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI040797261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1106361991OtherBCBS
MI1106361991OtherBCN
MI110F339390OtherBC GROUP
MI4792608Medicaid
MI110F339390OtherBCN
MI110F339390OtherBC GROUP
ON94750Medicare PIN