Healthcare Provider Details

I. General information

NPI: 1942559380
Provider Name (Legal Business Name): AVENUE HEMATOLOGY AND ONCOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2012
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54505 26TH ST STE C
SOUTH BEND IN
46635-1961
US

IV. Provider business mailing address

PO BOX 6128
SOUTH BEND IN
46660-6128
US

V. Phone/Fax

Practice location:
  • Phone: 574-968-4100
  • Fax: 574-968-4125
Mailing address:
  • Phone: 574-968-4100
  • Fax: 874-968-4125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM S KAMANDA
Title or Position: CEO
Credential:
Phone: 574-968-4100