Healthcare Provider Details

I. General information

NPI: 1982942306
Provider Name (Legal Business Name): ILLINOIS CANCER SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2013
Last Update Date: 03/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

396 REMINGTON BLVD STE 141
BOLINGBROOK IL
60440-4302
US

IV. Provider business mailing address

25070 NETWORK PL
CHICAGO IL
60673-1250
US

V. Phone/Fax

Practice location:
  • Phone: 630-754-8310
  • Fax:
Mailing address:
  • Phone: 847-585-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number363358247
License Number StateIL

VIII. Authorized Official

Name: DR. DAVID HAKIMIAN
Title or Position: MEDICAL DOCTOR
Credential: M.D.
Phone: 847-827-9490