# MIDWEST CENTER FOR CANCER & BLOOD, SC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366537292
- **Authorized official:** DR. RAMESH KOLA MD (PRESIDENT)
- **Authorized official phone:** (815) 786-9197

## Contact information

- **Practice address:** 15 W PLEASANT AVE, SANDWICH, IL 60548-1050
- **Practice address phone:** (815) 786-9197
- **Practice address fax:** (815) 786-9199
- **Mailing address:** 15 W PLEASANT AVE, SANDWICH, IL 60548-1050
- **Mailing address phone:** (815) 786-9197
- **Mailing address fax:** (815) 786-9199

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 042-618670 | IL | Yes |

## Other

- **Enumeration date:** 10/04/2006
- **Last updated:** 01/11/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 14D1047350 | CLIA \# | — |