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General NPI Number Information
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NPI Number | 1376505065
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Entity Type | Organization
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Legal Business Name | CANCER MEDICINE GROUP INC
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Dates
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Enumeration Date | 04/06/2006
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Last Update Date | 03/14/2013
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Provider Practice Location Address
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Address Line | 2301 E 93RD ST SUITE 110
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City | CHICAGO
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State | IL
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Zip | 60617-3913
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Country | US
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Telephone | 773-731-2982
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Fax | 773-731-3328
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Provider Business Mailing Address
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Address Line | 505 N LAKE SHORE DR SUITE 5811
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City | CHICAGO
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State | IL
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Zip | 60611-3427
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Country | US
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Telephone | 773-731-2982
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Fax | 773-731-3328
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Authorized Official
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Title or Position | OWNER
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Name | DR. NYAMBI EBIE
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Credential | M.D.
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Telephone | 773-731-3361
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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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