Healthcare Provider Details

I. General information

NPI: 1669496261
Provider Name (Legal Business Name): MIDWEST HEMATOLOGY ONCOLOGY CONSULTANTS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11125 DUNN ROAD SUITE #100
ST LOUIS MO
63136-6132
US

IV. Provider business mailing address

11125 DUNN ROAD SUITE #100
ST LOUIS MO
63136-6132
US

V. Phone/Fax

Practice location:
  • Phone: 314-355-5597
  • Fax: 314-355-5526
Mailing address:
  • Phone: 314-355-5597
  • Fax: 314-355-5526

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: THOMAS EDWARD RYAN
Title or Position: PRESIDENT
Credential: MD
Phone: 314-355-5597