Healthcare Provider Details

I. General information

NPI: 1336607555
Provider Name (Legal Business Name): CANCER SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 04/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 VALE PARK RD N UNIT A
VALPARAISO IN
46383-2546
US

IV. Provider business mailing address

100 E WAYNE ST STE 510
SOUTH BEND IN
46601-2394
US

V. Phone/Fax

Practice location:
  • Phone: 219-462-4400
  • Fax: 219-462-4401
Mailing address:
  • Phone: 574-334-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BILAL ANSARI
Title or Position: PRESIDENT
Credential: MD
Phone: 574-334-5400