Healthcare Provider Details

I. General information

NPI: 1740270628
Provider Name (Legal Business Name): SHANKAR C SANWALANI MD AND ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 11/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 INGALLS DR CANCER CARE CENTER
HARVEY IL
60426-3558
US

IV. Provider business mailing address

4647 LINCOLN HWY
MATTESON IL
60443-2319
US

V. Phone/Fax

Practice location:
  • Phone: 708-915-6620
  • Fax: 708-915-3782
Mailing address:
  • Phone: 708-747-5850
  • Fax: 708-747-9991

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: SHANKAR C SANWALANI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 708-915-6620