Provider Demographics
NPI:1215954029
Name:INTERMED ONCOLOGY
Entity type:Organization
Organization Name:INTERMED ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YUNUS
Authorized Official - Middle Name:T
Authorized Official - Last Name:NOMANBHOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-957-2100
Mailing Address - Street 1:17901 GOVERNORS HWY
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-1144
Mailing Address - Country:US
Mailing Address - Phone:708-957-2100
Mailing Address - Fax:708-957-4714
Practice Address - Street 1:17901 GOVERNORS HWY
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1144
Practice Address - Country:US
Practice Address - Phone:708-957-2100
Practice Address - Fax:708-957-4714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0293780001Medicare NSC
IL610860Medicare ID - Type Unspecified