Provider Demographics
NPI:1164483913
Name:ILLINOIS CANCER SPECIALISTS
Entity Type:Organization
Organization Name:ILLINOIS CANCER SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HAKIMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-585-7000
Mailing Address - Street 1:25070 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1250
Mailing Address - Country:US
Mailing Address - Phone:847-585-7000
Mailing Address - Fax:847-240-9093
Practice Address - Street 1:8915 W GOLF RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-5905
Practice Address - Country:US
Practice Address - Phone:847-827-9060
Practice Address - Fax:847-827-7196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1619809OtherBCBS
IL355030Medicare PIN
IL208179Medicare PIN
IL1619809OtherBCBS
ILCA0480Medicare PIN
IL355031Medicare PIN