Provider Demographics
NPI:1477691640
Name:MIDWEST ONCOLOGY HEMATOLOGY LTD
Entity Type:Organization
Organization Name:MIDWEST ONCOLOGY HEMATOLOGY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:LEQUN
Authorized Official - Last Name:CAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-717-6860
Mailing Address - Street 1:1600 N RANDALL RD
Mailing Address - Street 2:STE. 115
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-7803
Mailing Address - Country:US
Mailing Address - Phone:847-717-6860
Mailing Address - Fax:847-717-6872
Practice Address - Street 1:1600 N RANDALL RD
Practice Address - Street 2:STE. 115
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-2306
Practice Address - Country:US
Practice Address - Phone:847-717-6860
Practice Address - Fax:847-717-6872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098274207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04528012OtherBCBS OF IL
IL209037Medicare ID - Type UnspecifiedMCARE GROUP # LOC15
IL200912Medicare ID - Type UnspecifiedMCARE GRP # LOC16
IL04528012OtherBCBS OF IL