Provider Demographics
NPI:1962698837
Name:UNIVERSITY HEMATOLOGY ONCOLOGY GROUP INC.
Entity type:Organization
Organization Name:UNIVERSITY HEMATOLOGY ONCOLOGY GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RAZA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SYED
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:314-290-7501
Mailing Address - Street 1:4921 PARKVIEW PL
Mailing Address - Street 2:SUITE 14C
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1032
Mailing Address - Country:US
Mailing Address - Phone:314-290-7501
Mailing Address - Fax:314-290-7575
Practice Address - Street 1:1052 MARTIN LUTHER KING DR
Practice Address - Street 2:SUITE 2
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-3002
Practice Address - Country:US
Practice Address - Phone:314-290-7501
Practice Address - Fax:314-290-7575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-043159207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL8221935OtherBCBS IL
IL304010Medicare PIN