Healthcare Provider Details

I. General information

NPI: 1922287358
Provider Name (Legal Business Name): LUDAG LLC, DBA CANCER TREATMENT GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PROVENA WAY
BOURBONNAIS IL
60914-4796
US

IV. Provider business mailing address

PO BOX 85327
CHICAGO IL
60689-5327
US

V. Phone/Fax

Practice location:
  • Phone: 815-937-2460
  • Fax:
Mailing address:
  • Phone: 800-329-1906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT T WOODBURN
Title or Position: PRESIDENT
Credential: MD
Phone: 574-271-2558