Healthcare Provider Details

I. General information

NPI: 1114030145
Provider Name (Legal Business Name): RADIATION ONCOLOGY ASSOCIATES OF MICHIANA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 LAKE AVE
PLYMOUTH IN
46563-9366
US

IV. Provider business mailing address

1915 LAKE AVE
PLYMOUTH IN
46563-9366
US

V. Phone/Fax

Practice location:
  • Phone: 574-271-2558
  • Fax: 574-273-1137
Mailing address:
  • Phone:
  • Fax:

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: JAN RHODES
Title or Position: BILLING ADMINISTRATOR
Credential:
Phone: 574-271-2558