Provider Demographics
NPI:1578610846
Name:JOLIET ONCOLOGY HEMATOLOGY ASSOCIATES, LTD.
Entity Type:Organization
Organization Name:JOLIET ONCOLOGY HEMATOLOGY ASSOCIATES, LTD.
Other - Org Name:FLOSSMOOR CANCER CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SARODE
Authorized Official - Middle Name:K
Authorized Official - Last Name:PUNDALEEKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-725-1355
Mailing Address - Street 1:2614 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6433
Mailing Address - Country:US
Mailing Address - Phone:815-725-1355
Mailing Address - Fax:815-725-9861
Practice Address - Street 1:3235 VOLLMER RD
Practice Address - Street 2:SUITE 120
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2013
Practice Address - Country:US
Practice Address - Phone:708-957-3454
Practice Address - Fax:708-957-3495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208256Medicare ID - Type Unspecified
IL205474Medicare ID - Type Unspecified
IL336140Medicare ID - Type Unspecified