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General NPI Number Information
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NPI Number | 1942414412
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Entity Type | Organization
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Legal Business Name | SUBURBAN HEMATOLOGY ONCOLOGY INC
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 10/25/2007
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Provider Practice Location Address
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Address Line | 3619 PARK EAST DR SUITE 211
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City | BEACHWOOD
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State | OH
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Zip | 44122-4330
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Country | US
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Telephone | 216-378-0900
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Fax | 216-378-1853
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Provider Business Mailing Address
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Address Line | 6463 TAYLOR MILL RD
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City | INDEPENDENCE
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State | KY
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Zip | 41051-9392
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Country | US
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Telephone | 859-363-4900
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Fax | 859-363-4986
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALAN WINE
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Credential | M.D.
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Telephone | 216-378-0900
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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 | WI032845
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License Number State | OH
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