Provider Demographics
NPI:1275729550
Name:UNIVERSITY HEMATOLOGY ONCOLOGY GROUP INC.
Entity Type:Organization
Organization Name:UNIVERSITY HEMATOLOGY ONCOLOGY GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RAZA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SYED
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:314-290-7501
Mailing Address - Street 1:4921 PARKVIEW PL
Mailing Address - Street 2:SUITE 14C
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1032
Mailing Address - Country:US
Mailing Address - Phone:314-290-7501
Mailing Address - Fax:314-290-7575
Practice Address - Street 1:2210 BARRON RD
Practice Address - Street 2:SUITE 117
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-1908
Practice Address - Country:US
Practice Address - Phone:573-778-9136
Practice Address - Fax:573-778-9172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3981207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO505740506Medicaid
MO000013533Medicare PIN