MEDICARE: JOLIET ONCOLOGY HEMATOLOGY ASSOCIATES LTD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RX0202X	Medical Oncology Physician		IL

General Provider Information

NPI Number	:	1467509711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOLIET ONCOLOGY HEMATOLOGY ASSOCIATES LTD.

Provider Business Mailing Address
First Line	:	2614 W JEFFERSON ST
Second Line	:
City	:	JOLIET
State	:	IL
Zip	:	60435-6433
Country	:	US
Telephone Number	:	815-725-1355
Fax Number	:	815-725-9861

Provider Business Practice Location Address
First Line	:	1301 COPPERFIELD AVE
Second Line	:
City	:	JOLIET
State	:	IL
Zip	:	60432-2054
Country	:	US
Telephone Number	:	815-723-8939
Fax Number	:	815-725-8995

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SARODE K PUNDALEEKA
Credential	:	M.D.
Telephone Number	:	815-725-1355

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	08/22/2020

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