Provider Demographics
NPI:1295814788
Name:LAGRANGE ONCOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:LAGRANGE ONCOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:WESOLOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-579-3418
Mailing Address - Street 1:302 RANDALL RD STE 20
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4209
Mailing Address - Country:US
Mailing Address - Phone:630-232-0610
Mailing Address - Fax:630-232-0675
Practice Address - Street 1:302 RANDALL RD STE 20
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4209
Practice Address - Country:US
Practice Address - Phone:630-232-0610
Practice Address - Fax:630-232-0675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL588770Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER