Organization
AVENUE HEMATOLOGY AND ONCOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM S KAMANDA (CEO)
(574) 968-4100
Entity
Organization
Contact information
Practice address
54505 26TH ST STE C, SOUTH BEND, IN 46635-1961
(574) 968-4100
(574) 968-4125
Mailing address
PO BOX 6128, SOUTH BEND, IN 46660-6128
(574) 968-4100
(874) 968-4125
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IN1050
MEDICARE PART B INDIANA
IN
01
—
MI7766
MEDICARE PART B MICHIGAN
MI
Enumeration date
08/30/2012
Last updated
06/06/2025
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