Provider Demographics
NPI:1376505065
Name:CANCER MEDICINE GROUP INC
Entity Type:Organization
Organization Name:CANCER MEDICINE GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NYAMBI
Authorized Official - Middle Name:
Authorized Official - Last Name:EBIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-731-3361
Mailing Address - Street 1:505 N LAKE SHORE DR
Mailing Address - Street 2:SUITE 5811
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3427
Mailing Address - Country:US
Mailing Address - Phone:773-731-2982
Mailing Address - Fax:773-731-3328
Practice Address - Street 1:2301 E 93RD ST
Practice Address - Street 2:SUITE 110
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-3913
Practice Address - Country:US
Practice Address - Phone:773-731-2982
Practice Address - Fax:773-731-3328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1376505065OtherGROUP NPI
IL1376505065OtherNPI - GROUP
IL210946Medicare PIN
IL1376505065OtherNPI - GROUP