Community Cancer Care Specialists

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

Legal business name

COMMUNITY CANCER CARE SPECIALISTS

Doing business as

Paul M Derderian DO

Practice address

1030 Harrington St
Ste 301
Mount Clemens, MI 48043-2967

Phone

(586) 493-3440

Fax

(586) 493-3455

NPI assigned

Aug 22, 2006

Last updated

Sep 11, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Leslie Nowak

Title

Practice Manager

Phone

(586) 493-3435

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• PAUL M DERDERIAN DO Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1407962442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1030 HARRINGTON ST",
            "address_2": "STE 301",
            "city": "MOUNT CLEMENS",
            "state": "MI",
            "postal_code": "480432967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 HARRINGTON ST",
            "address_2": "STE 301",
            "city": "MOUNT CLEMENS",
            "state": "MI",
            "postal_code": "480432967",
            "telephone_number": "586-493-3440",
            "fax_number": "586-493-3455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY CANCER CARE SPECIALISTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-22",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "NOWAK",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "586-493-3435"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5101009575",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "2368430",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PAUL M DERDERIAN DO",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lauren Therese Cody, RD, IBCLC
• James Arthur Coleman
• Shelia Renee Collins, LLMSW
• Wallace Spurgeon Colvin III, D.D.S.
• Comfort Prosthetics & Orthotics Inc
• Community Cancer Care Specialists
• Comprehensive Youth Services Inc (Clinton Counseling Center)
• Maurica Cook
• Jessica Cooley, AGAC-NP
• Jaret M Copeman, D.O.

• Non-Pharmacy Dispensing Site in Mount Clemens, MI
• Providers in Mount Clemens, MI by specialty
• Non-Pharmacy Dispensing Site in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.