Provider Demographics
NPI:1538248745
Name:INTERMED ONCOLOGY ASSOCIATES
Entity type:Organization
Organization Name:INTERMED ONCOLOGY ASSOCIATES
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:708-342-1900
Mailing Address - Street 1:17901 GOVERNORS HWY
Mailing Address - Street 2:SUITE 106
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:
Practice Address - Street 1:6701 159TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1758
Practice Address - Country:US
Practice Address - Phone:708-342-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036042369174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1616111OtherBCBS ID
IL610860Medicare ID - Type UnspecifiedMEDICARE ID
IL1616111OtherBCBS ID