MEDICARE: CHICAGO RADIATION ONCOLOGY, S.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0203X	Therapeutic Radiology Physician	036045136	IL

General Provider Information

NPI Number	:	1487606315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGO RADIATION ONCOLOGY, S.C.

Provider Business Mailing Address
First Line	:	609 SHERIDAN RD
Second Line	:
City	:	GLENCOE
State	:	IL
Zip	:	60022-1742
Country	:	US
Telephone Number	:	312-842-7309
Fax Number	:	312-842-7491

Provider Business Practice Location Address
First Line	:	2839 S ELLIS AVE
Second Line	:	MR-148
City	:	CHICAGO
State	:	IL
Zip	:	60616-2906
Country	:	US
Telephone Number	:	312-842-9600
Fax Number	:	312-842-9679

Authorized Official
Title or Position	:	OWNER
Name	:	DEAN MOHAMMAD AMEEN
Credential	:	M.D.
Telephone Number	:	312-842-7309

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	04/13/2009

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