Basic Information
| Provider Information | |||||||||
| NPI: | 1508811423 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EVANSVILLE CANCER CARE, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 15040 | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477160040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124761367 | ||||||||
| FaxNumber: | 8124774153 | ||||||||
| Practice Location | |||||||||
| Address1: | 1418 COLLEGE DR | ||||||||
| Address2: | |||||||||
| City: | MOUNT CARMEL | ||||||||
| State: | IL | ||||||||
| PostalCode: | 628632638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124741110 | ||||||||
| FaxNumber: | 8124732619 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | HADAD | ||||||||
| AuthorizedOfficialFirstName: | LOTFI | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8124741110 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MEDICAL DOCTOR | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0000X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology | 207RH0003X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RX0202X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
No ID Information.