| Avenue Hematology And Oncology Llc | |
|
54505 26th St Ste C South Bend IN 46635-1961 | |
| (574) 968-4100 | |
| (574) 968-4125 |
| Full Name | Avenue Hematology And Oncology Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 54505 26th St Ste C, South Bend, Indiana |
| Authorized Official Name and Position | William S Kamanda (CEO) |
| Authorized Official Contact | 5749684100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Avenue Hematology And Oncology Llc Po Box 6128 South Bend IN 46660-6128 Ph: (574) 968-4100 | Avenue Hematology And Oncology Llc 54505 26th St Ste C South Bend IN 46635-1961 Ph: (574) 968-4100 |
| NPI Number | 1942559380 |
|---|---|
| Provider Enumeration Date | 08/30/2012 |
| Last Update Date | 06/06/2025 |
| Medicare PECOS PAC ID | 4082864921 |
|---|---|
| Medicare Enrollment ID | O20121030000357 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942559380 | NPI | - | NPPES |
| IN1050 | Other | IN | MEDICARE PART B INDIANA |
| MI7766 | Other | MI | MEDICARE PART B MICHIGAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 261QM2500X | Clinic/center - Medical Specialty | (* (Not Available)) | Primary |
| Provider Name | William S Kamanda |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1275597650 PECOS PAC ID: 3870562085 Enrollment ID: I20040924000833 |
| Provider Name | Maureen A Ziboh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275560583 PECOS PAC ID: 9830137421 Enrollment ID: I20050423000060 |
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