Healthcare Provider Details

I. General information

NPI: 1760482160
Provider Name (Legal Business Name): SHANKAR C SANWALANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
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

14927 CRYSTAL SPRINGS CT
ORLAND PARK IL
60467-9101
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number036048573
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: