Provider Demographics
NPI:1679658983
Name:HEMATOLOGY ONCOLOGY SPECIALTY SC
Entity Type:Organization
Organization Name:HEMATOLOGY ONCOLOGY SPECIALTY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HUSAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:TARAWNEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-968-9190
Mailing Address - Street 1:N53W16184 WHITETAIL RUN
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-0628
Mailing Address - Country:US
Mailing Address - Phone:262-703-0116
Mailing Address - Fax:
Practice Address - Street 1:2900 W OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4330
Practice Address - Country:US
Practice Address - Phone:414-649-6380
Practice Address - Fax:414-649-5389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31619207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31671000Medicaid
WIE67832Medicare UPIN