Healthcare Provider Details

I. General information

NPI: 1518109552
Provider Name (Legal Business Name): COOK COUNTY RADIATION ONCOLOGY,SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7531 S STONY ISLAND AVE BASEMENT
CHICAGO IL
60649-3954
US

IV. Provider business mailing address

7531 S STONEY ISLAND AVE BASEMENT
CHICAGO IL
60649-3954
US

V. Phone/Fax

Practice location:
  • Phone: 773-947-7851
  • Fax: 773-947-7840
Mailing address:
  • Phone: 773-947-7851
  • Fax: 773-947-7840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number036073542
License Number StateIL

VIII. Authorized Official

Name: MRS. COLLEEN M SLATTERY
Title or Position: BILLING MANAGER
Credential:
Phone: 708-429-6213