Provider Demographics
NPI:1477740447
Name:UNIVERSITY HEMATOLOGY ONCOLOGY GROUP INC
Entity Type:Organization
Organization Name:UNIVERSITY HEMATOLOGY ONCOLOGY GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTIVE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RAZA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SYED
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:314-290-7501
Mailing Address - Street 1:4921 PARKVIEW PL
Mailing Address - Street 2:SUITE 14C
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1032
Mailing Address - Country:US
Mailing Address - Phone:314-290-7501
Mailing Address - Fax:314-290-7550
Practice Address - Street 1:13 WOLF CREEK DR
Practice Address - Street 2:SUITE 1
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2355
Practice Address - Country:US
Practice Address - Phone:618-532-1807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216083Medicare UPIN