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General NPI Number Information
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NPI Number | 1366537292
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Entity Type | Organization
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Legal Business Name | MIDWEST CENTER FOR CANCER & BLOOD, SC
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 01/11/2013
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Provider Practice Location Address
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Address Line | 15 W PLEASANT AVE
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City | SANDWICH
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State | IL
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Zip | 60548-1050
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Country | US
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Telephone | 815-786-9197
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Fax | 815-786-9199
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Provider Business Mailing Address
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Address Line | 15 W PLEASANT AVE
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City | SANDWICH
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State | IL
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Zip | 60548-1050
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Country | US
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Telephone | 815-786-9197
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Fax | 815-786-9199
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAMESH KOLA
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Credential | MD
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Telephone | 815-786-9197
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 042-618670
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License Number State | IL
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