Provider Demographics
NPI:1346427911
Name:MEDONC LTD
Entity Type:Organization
Organization Name:MEDONC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:AYOOLA
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:AWOFADEJU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-955-6415
Mailing Address - Street 1:3703 BALLANTRAE WAY
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-4316
Mailing Address - Country:US
Mailing Address - Phone:708-955-6415
Mailing Address - Fax:
Practice Address - Street 1:3703 BALLANTRAE WAY
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-4316
Practice Address - Country:US
Practice Address - Phone:708-955-6415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-26
Last Update Date:2008-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC3459OtherRAILROAD MEDICARE
207191Medicare PIN
DC3459OtherRAILROAD MEDICARE