Provider Demographics
NPI:1184859183
Name:ULTIMATE CARE ONCOLOGY
Entity Type:Organization
Organization Name:ULTIMATE CARE ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONCOLOGY & HEMATOLOGY
Authorized Official - Prefix:MR
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:JAJEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-770-6400
Mailing Address - Street 1:5611 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-5302
Mailing Address - Country:US
Mailing Address - Phone:773-770-6400
Mailing Address - Fax:773-385-5375
Practice Address - Street 1:5611 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-5302
Practice Address - Country:US
Practice Address - Phone:773-770-6400
Practice Address - Fax:773-385-5375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036082665Medicaid
ILP00680760Medicare PIN
IL964290003Medicare PIN
ILH82967Medicare UPIN