Healthcare Provider Details

I. General information

NPI: 1376505065
Provider Name (Legal Business Name): CANCER MEDICINE GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 E 93RD ST SUITE 110
CHICAGO IL
60617-3913
US

IV. Provider business mailing address

505 N LAKE SHORE DR SUITE 5811
CHICAGO IL
60611-3427
US

V. Phone/Fax

Practice location:
  • Phone: 773-731-2982
  • Fax: 773-731-3328
Mailing address:
  • Phone: 773-731-2982
  • Fax: 773-731-3328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. NYAMBI EBIE
Title or Position: OWNER
Credential: M.D.
Phone: 773-731-3361