Provider Demographics
NPI:1669496261
Name:MIDWEST HEMATOLOGY ONCOLOGY CONSULTANTS LTD
Entity Type:Organization
Organization Name:MIDWEST HEMATOLOGY ONCOLOGY CONSULTANTS LTD
Other - Org Name:HEMATOLOGY ONCOLOGY CONSULTANTS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-355-5597
Mailing Address - Street 1:11125 DUNN ROAD
Mailing Address - Street 2:SUITE #100
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-6132
Mailing Address - Country:US
Mailing Address - Phone:314-355-5597
Mailing Address - Fax:314-355-5526
Practice Address - Street 1:11125 DUNN ROAD
Practice Address - Street 2:SUITE #100
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6132
Practice Address - Country:US
Practice Address - Phone:314-355-5597
Practice Address - Fax:314-355-5526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL923840Medicare PIN