Provider Demographics
NPI:1689896862
Name:EVANSVILLE CANCER CARE PC
Entity Type:Organization
Organization Name:EVANSVILLE CANCER CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOTFI
Authorized Official - Middle Name:
Authorized Official - Last Name:HADAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-475-1948
Mailing Address - Street 1:PO BOX 5646
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47716-5646
Mailing Address - Country:US
Mailing Address - Phone:812-475-1948
Mailing Address - Fax:812-401-5777
Practice Address - Street 1:724 N BURKHARDT RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-2740
Practice Address - Country:US
Practice Address - Phone:812-475-1948
Practice Address - Fax:812-401-5777
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVANSVILLE CANCER CARE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-03
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01063229A207RI0200X
IN01059087A207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN234140Medicare PIN