1578610846 NPI number — JOLIET ONCOLOGY HEMATOLOGY ASSOCIATES, LTD.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578610846 NPI number — JOLIET ONCOLOGY HEMATOLOGY ASSOCIATES, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOLIET ONCOLOGY HEMATOLOGY ASSOCIATES, LTD.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578610846
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2614 W JEFFERSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOLIET
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60435-6433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-725-1355
Provider Business Mailing Address Fax Number:
815-725-9861

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3235 VOLLMER RD
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
FLOSSMOOR
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60422-2013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-957-3454
Provider Business Practice Location Address Fax Number:
708-957-3495
Provider Enumeration Date:
01/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PUNDALEEKA
Authorized Official First Name:
SARODE
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
815-725-1355

Provider Taxonomy Codes

  • Taxonomy code: 207RX0202X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com