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NPI Code Detail

MEDICARE: UNIVERSITY HEMATOLOGY ONCOLOGY GROUP INC

MEDICARE: UNIVERSITY HEMATOLOGY ONCOLOGY GROUP INC
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
1261QX0200XOncology Clinic/Center

General Provider Information

NPI Number : 1477740447
Entity Type Code : Organization
Provider Name (Legal Business Name) : UNIVERSITY HEMATOLOGY ONCOLOGY GROUP INC
Provider Business Mailing Address
First Line : 4921 PARKVIEW PL
Second Line : SUITE 14C
City : SAINT LOUIS
State : MO
Zip : 63110-1032
Country : US
Telephone Number : 314-290-7501
Fax Number : 314-290-7550
Provider Business Practice Location Address
First Line : 13 WOLF CREEK DR
Second Line : SUITE 1
City : SWANSEA
State : IL
Zip : 62226-2355
Country : US
Telephone Number : 618-532-1807
Fax Number :
Authorized Official
Title or Position : PRACTIVE ADMINISTRATOR
Name : RAZA M SYED
Credential : MBA
Telephone Number : 314-290-7501
Provider Enumeration Date : 10/03/2007
Last Update Date : 05/07/2008

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