Organization
MEDONC LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AYOOLA SAMUEL AWOFADEJU MD (PRESIDENT/CEO)
(708) 955-6415
Entity
Organization
Contact information
Practice address
3703 BALLANTRAE WAY, FLOSSMOOR, IL 60422-4316
(708) 955-6415
Mailing address
3703 BALLANTRAE WAY, FLOSSMOOR, IL 60422-4316
(708) 955-6415
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DC3459
RAILROAD MEDICARE
—
Enumeration date
01/26/2008
Last updated
01/26/2008
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