Provider Demographics
NPI:1952498628
Name:JOLIET ONCOLOGY HEMATOLOGY ASSOCIATES LTD
Entity Type:Organization
Organization Name:JOLIET ONCOLOGY HEMATOLOGY ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SARODE
Authorized Official - Middle Name:
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:815-725-9867
Practice Address - Street 1:2614 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6433
Practice Address - Country:US
Practice Address - Phone:815-725-1355
Practice Address - Fax:815-725-9861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Single Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09919437OtherBCBS
336140Medicare ID - Type Unspecified
IL09919437OtherBCBS
205474Medicare ID - Type Unspecified
208256Medicare ID - Type Unspecified