Healthcare Provider Details

I. General information

NPI: 1922114453
Provider Name (Legal Business Name): ILLINOIS CANCER SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 03/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 W MEDICAL CENTER DR STE 1
MCHENRY IL
60050-8425
US

IV. Provider business mailing address

25070 NETWORK PL
CHICAGO IL
60673-1250
US

V. Phone/Fax

Practice location:
  • Phone: 815-363-0066
  • Fax: 815-385-2812
Mailing address:
  • Phone: 847-585-7000
  • Fax: 847-640-0622

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. DAVID HAKIMIAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 847-827-9060