Healthcare Provider Details

I. General information

NPI: 1669507034
Provider Name (Legal Business Name): CANCER THERAPY ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1263 S HIGHLAND AVE SUITE 100
LOMBARD IL
60148-4516
US

IV. Provider business mailing address

436 N COUNTY LINE RD
HINSDALE IL
60521-3804
US

V. Phone/Fax

Practice location:
  • Phone: 630-261-0280
  • Fax:
Mailing address:
  • Phone: 630-261-0280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: JOHN A. GREAGER II
Title or Position: PRESIDENT
Credential: M.D.
Phone: 630-261-0280