Provider Demographics
NPI:1255328464
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:
Authorized Official - Phone:847-827-9060
Mailing Address - Street 1:PO BOX 25070
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:847-640-0622
Practice Address - Street 1:1710 N RANDALL RD
Practice Address - Street 2:STE 300
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-9400
Practice Address - Country:US
Practice Address - Phone:847-931-0909
Practice Address - Fax:847-931-0939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL582420Medicare ID - Type UnspecifiedLOCAL 99 WOODSTOCK/MCHENR
IL582400Medicare ID - Type UnspecifiedLOCAL 16 COOK
IL4766570002Medicare NSC
IL582420Medicare UPIN
IL582400Medicare UPIN
IL582410Medicare UPIN
IL582410Medicare ID - Type UnspecifiedLOCAL 15 KANE