MEDICARE: COOK COUNTY MEDICAL RESEARCH

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	207RH0003X	Hematology & Oncology Physician

General Provider Information

NPI Number	:	1861789877
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COOK COUNTY MEDICAL RESEARCH

Provider Business Mailing Address
First Line	:	PO BOX 9005
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60567-0005
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4809 W MADISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60644-3640
Country	:	US
Telephone Number	:	773-473-7800
Fax Number	:	773-473-7801

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	SADHNA MOHAAN
Credential	:
Telephone Number	:	630-375-6500

Provider Enumeration Date	:	06/29/2011
Last Update Date	:	07/01/2011

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