Provider Demographics
NPI:1962436204
Name:ONCOLOGY OF NORTHSHORE CLINIC PLLC
Entity type:Organization
Organization Name:ONCOLOGY OF NORTHSHORE CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DR
Authorized Official - Prefix:DR
Authorized Official - First Name:BASSAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:MATAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-871-1800
Mailing Address - Street 1:2000 GOLF RD
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-4216
Mailing Address - Country:US
Mailing Address - Phone:847-871-1800
Mailing Address - Fax:847-871-1811
Practice Address - Street 1:2000 GOLF RD
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008
Practice Address - Country:US
Practice Address - Phone:847-871-1800
Practice Address - Fax:847-629-4937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036095552OtherSTATE LICENSE NUMBER
IL036095552Medicaid
IL5817580001Medicare NSC
ILL70180Medicare PIN