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General NPI Number Information
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NPI Number | 1093069528
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Entity Type | Individual
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Provider Name | ALEX HERSKOVIC M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/06/2012
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 200 RIVERSIDE DR
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City | BOURBONNAIS
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State | IL
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Zip | 60914-4689
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Country | US
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Telephone | 815-933-9660
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Fax | 815-929-0014
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Provider Business Mailing Address
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Address Line | 200 RIVERSIDE DR
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City | BOURBONNAIS
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State | IL
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Zip | 60914-4689
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Country | US
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Telephone | 815-933-9660
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Fax | 815-929-0014
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 44416
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 036143812
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License Number State | IL
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