Healthcare Provider Details

I. General information

NPI: 1659449163
Provider Name (Legal Business Name): PEDIATRIC CANCER INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W.95TH STREET
OAK LAWN IL
60453
US

IV. Provider business mailing address

4440 W.95TH STREET
OAK LAWN IL
60453
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-4094
  • Fax: 708-684-5141
Mailing address:
  • Phone: 708-684-4094
  • Fax: 708-684-5141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: SHARAD N SALVI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 708-684-4094