Healthcare Provider Details

I. General information

NPI: 1649343864
Provider Name (Legal Business Name): ILLINOIS CANCER SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8915 W GOLF RD
NILES IL
60714-5905
US

IV. Provider business mailing address

25070 NETWORK PL
CHICAGO IL
60673-1250
US

V. Phone/Fax

Practice location:
  • Phone: 847-954-3480
  • Fax: 847-827-1574
Mailing address:
  • Phone: 847-585-7000
  • Fax: 847-240-0622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054014868
License Number StateIL

VIII. Authorized Official

Name: RIA DALMACIO
Title or Position: NETWORK CONTRACTING REPRESENTATIVE
Credential:
Phone: 312-520-4757