Provider Demographics
NPI:1538120381
Name:HEMATOLOGY ONCOLOGY ASSOCIATES OF ILLINOIS LLC
Entity Type:Organization
Organization Name:HEMATOLOGY ONCOLOGY ASSOCIATES OF ILLINOIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STATE BUSINESS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:T
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-585-7012
Mailing Address - Street 1:25068 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1250
Mailing Address - Country:US
Mailing Address - Phone:847-585-7000
Mailing Address - Fax:847-240-9093
Practice Address - Street 1:676 N ST CLAIR
Practice Address - Street 2:SUITE 2140
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-664-5400
Practice Address - Fax:312-664-5854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1616101OtherBCBS
IL218890Medicare PIN
IL397530Medicare PIN
IL218940Medicare PIN
ILCD7345Medicare PIN
IL1616101OtherBCBS
IL218860Medicare PIN
IL397450Medicare PIN