Healthcare Provider Details

I. General information

NPI: 1902897358
Provider Name (Legal Business Name): ROTATING GAMMA SYSTEM INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 01/16/2008
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

PO BOX 82388
AUSTIN TX
78708-2388
US

V. Phone/Fax

Practice location:
  • Phone: 847-249-3090
  • Fax: 847-623-4628
Mailing address:
  • Phone: 512-583-0205
  • Fax: 512-583-2001

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: DR. YASHBIR MEHTA
Title or Position: OFFICER
Credential: MD
Phone: 847-249-3090