Provider Demographics
NPI:1821450321
Name:SOUTH CHICAGO ONCOLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:SOUTH CHICAGO ONCOLOGY ASSOCIATES LLC
Other - Org Name:ADVANCED CANCER CARE CENTER ILLINOIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:T
Authorized Official - Last Name:HUSSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-906-3700
Mailing Address - Street 1:161 S LINCOLNWAY STE 210
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-1660
Mailing Address - Country:US
Mailing Address - Phone:630-906-3700
Mailing Address - Fax:
Practice Address - Street 1:161 S LINCOLNWAY STE 210
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-1660
Practice Address - Country:US
Practice Address - Phone:630-906-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-23
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084973207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty