Healthcare Provider Details

I. General information

NPI: 1124375274
Provider Name (Legal Business Name): ALEC BLOCK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 SOUTH FIRST AVE LOYOLA RADATION ONCOLOGY
MAYWOOD IL
60153
US

IV. Provider business mailing address

2160 SOUTH FIRST AVE LOYOLA RADATION ONCOLOGY
MAYWOOD IL
60153
US

V. Phone/Fax

Practice location:
  • Phone: 708-216-2729
  • Fax: 708-216-5924
Mailing address:
  • Phone: 708-216-2729
  • Fax: 708-216-5924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number125061878
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number036142638
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: