Healthcare Provider Details

I. General information

NPI: 1902030661
Provider Name (Legal Business Name): JOLIET ONCOLOGY HEMATOLOGY ASSOCIATES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2009
Last Update Date: 05/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 HIGHLAND AVE # 2L,TOWER 1
DOWNERS GROVE IL
60515-1552
US

IV. Provider business mailing address

2614 W JEFFERSON ST
JOLIET IL
60435-6433
US

V. Phone/Fax

Practice location:
  • Phone: 630-663-0061
  • Fax: 815-723-8995
Mailing address:
  • Phone: 815-725-1355
  • Fax: 815-725-9861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number036052030
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number036052030
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number036052030
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036052030
License Number StateIL

VIII. Authorized Official

Name: DR. SARODE K PUNDALEEKA
Title or Position: PRESIDENT
Credential: MD
Phone: 815-725-1355