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General NPI Number Information
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NPI Number | 1326127812
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Entity Type | Organization
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Legal Business Name | LAGRANGE ONCOLOGY ASSOCIATES, S.C.
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 07/21/2008
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Provider Practice Location Address
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Address Line | 1325 MEMORIAL DR
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City | LA GRANGE
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State | IL
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Zip | 60525-2659
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Country | US
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Telephone | 708-579-3418
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Fax | 708-579-3485
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Provider Business Mailing Address
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Address Line | PO BOX 2009
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City | CAROL STREAM
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State | IL
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Zip | 60132-0001
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Country | US
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Telephone | 708-579-3418
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Fax | 708-579-3485
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MS. CHERYL WESOLOWSKI
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Credential | CMPE
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Telephone | 708-579-3418
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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