Provider Demographics
NPI:1326127812
Name:LAGRANGE ONCOLOGY ASSOCIATES, S.C.
Entity Type:Organization
Organization Name:LAGRANGE ONCOLOGY ASSOCIATES, S.C.
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:CMPE
Authorized Official - Phone:708-579-3418
Mailing Address - Street 1:PO BOX 2009
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60132-0001
Mailing Address - Country:US
Mailing Address - Phone:708-579-3418
Mailing Address - Fax:708-579-3485
Practice Address - Street 1:1325 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-2659
Practice Address - Country:US
Practice Address - Phone:708-579-3418
Practice Address - Fax:708-579-3485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL365730Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
IL588770Medicare PIN