Healthcare Provider Details

I. General information

NPI: 1245666569
Provider Name (Legal Business Name): RADIATION ONCOLOGY OF CHICAGO, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2013
Last Update Date: 04/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 W 95TH ST
EVERGREEN PARK IL
60805-2701
US

IV. Provider business mailing address

500 W SUPERIOR ST UNIT 1701
CHICAGO IL
60654-8132
US

V. Phone/Fax

Practice location:
  • Phone: 708-229-5560
  • Fax: 708-229-4712
Mailing address:
  • Phone: 708-229-5560
  • Fax: 708-229-4712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: ADAM DICKLER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 708-229-5560