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General NPI Number Information
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NPI Number | 1568694636
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Entity Type | Organization
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Legal Business Name | M I M HEMATOLOGY-ONCOLOGY LLC
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Dates
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Enumeration Date | 08/21/2009
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 225 EDWARD ST
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City | SYCAMORE
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State | IL
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Zip | 60178
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Country | US
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Telephone | 630-204-3015
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Fax |
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Provider Business Mailing Address
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Address Line | 1903 SADDLE FARM LN
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City | NAPERVILLE
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State | IL
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Zip | 60564-4501
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Country | US
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Telephone | 630-204-3015
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MOHAMMED ISHAQE MEMON
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Credential | M.D
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Telephone | 630-204-3015
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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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