Healthcare Provider Details

I. General information

NPI: 1831184654
Provider Name (Legal Business Name): ROCKFORD RADIATION ONCOLOGY LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 N ROCKTON AVE DEPT RADIATION ONCOLOGY
ROCKFORD IL
61103-3655
US

IV. Provider business mailing address

320 N ALPINE RD SUITE 208
ROCKFORD IL
61107-4975
US

V. Phone/Fax

Practice location:
  • Phone: 815-971-6188
  • Fax: 815-968-9677
Mailing address:
  • Phone: 815-227-4520
  • Fax: 815-229-5441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN M SMOROWSKI
Title or Position: CORPORATE PRESIDENT/OWNER
Credential: MD
Phone: 815-971-6188