Healthcare Provider Details

I. General information

NPI: 1891011326
Provider Name (Legal Business Name): STEREOTACTIC RADIOSURGERY INSTITUTE SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 N GREENLEAF ST
GURNEE IL
60031-3309
US

IV. Provider business mailing address

365 BATEMAN RD
BARRINGTON IL
60010-7616
US

V. Phone/Fax

Practice location:
  • Phone: 847-249-3090
  • Fax: 224-365-4100
Mailing address:
  • Phone: 847-249-3090
  • Fax: 224-365-4100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number036066061
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number036066061
License Number StateIL

VIII. Authorized Official

Name: DR. TOMASZ K HELENOWSKI
Title or Position: PRESIDENT
Credential: MD
Phone: 847-249-3090