Healthcare Provider Details

I. General information

NPI: 1457693079
Provider Name (Legal Business Name): ERIC P. XANTHOPOULOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BELOIT HEALTH SYSTEM UW CANCER CENTER 1670 LEE LANE
BELOIT WI
53511-3935
US

IV. Provider business mailing address

BELOIT HEALTH SYSTEM INC 1905 E. HUEBBE PARKWAY
BELOIT WI
53511-1842
US

V. Phone/Fax

Practice location:
  • Phone: 608-364-5253
  • Fax: 608-364-5252
Mailing address:
  • Phone: 608-364-2293
  • Fax: 608-364-5452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number036-146949
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number68909-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: