Provider Demographics
NPI:1871907790
Name:UNIVERSITY HEMATOLOGY ONCOLOGY INC
Entity type:Organization
Organization Name:UNIVERSITY HEMATOLOGY ONCOLOGY 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 1:2325 DOUGHERTY FERRY RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-3356
Mailing Address - Country:US
Mailing Address - Phone:314-290-7501
Mailing Address - Fax:314-290-7575
Practice Address - Street 1:#11 CUSUMANO PROFESSIONAL PLAZA
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864
Practice Address - Country:US
Practice Address - Phone:618-532-1891
Practice Address - Fax:618-532-1892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-043-159174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty