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NPI Code Detail

MEDICARE: MID-ILLINOIS HEMATOLOGY ONCOLOGY ASSOCIATES LTD

MEDICARE: MID-ILLINOIS HEMATOLOGY ONCOLOGY ASSOCIATES LTD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RH0003XHematology & Oncology Physician

General Provider Information

NPI Number : 1467467803
Entity Type Code : Organization
Provider Name (Legal Business Name) : MID-ILLINOIS HEMATOLOGY ONCOLOGY ASSOCIATES LTD
Provider Business Mailing Address
First Line : 1606 HUNT DR
Second Line :
City : NORMAL
State : IL
Zip : 61761-2192
Country : US
Telephone Number : 309-452-9701
Fax Number : 309-454-1957
Provider Business Practice Location Address
First Line : 1606 HUNT DR
Second Line :
City : NORMAL
State : IL
Zip : 61761-2192
Country : US
Telephone Number : 309-452-9701
Fax Number : 309-454-1957
Authorized Official
Title or Position : PRESIDENT
Name : DR. PRAMERN SRIRATANA
Credential : M.D.
Telephone Number : 309-452-9701
Provider Enumeration Date : 07/31/2006
Last Update Date : 12/12/2024

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Directions to “MID-ILLINOIS HEMATOLOGY ONCOLOGY ASSOCIATES LTD ” Practice Location

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