Healthcare Provider Details

I. General information

NPI: 1144523895
Provider Name (Legal Business Name): CDH CANCER CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2010
Last Update Date: 12/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 WEAVER PKWY
WARRENVILLE IL
60555-3269
US

IV. Provider business mailing address

0N025 WINFIELD RD
WINFIELD IL
60190-1237
US

V. Phone/Fax

Practice location:
  • Phone: 630-352-5300
  • Fax:
Mailing address:
  • Phone: 630-933-1600
  • Fax: 630-933-2766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number000000216
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number000000216
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number000000216
License Number StateIL

VIII. Authorized Official

Name: MAUREEN A TAUS
Title or Position: VP, FINANCE AND CONTROLLER
Credential:
Phone: 630-933-6342