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General NPI Number Information
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NPI Number | 1437391752
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Entity Type | Organization
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Legal Business Name | COOK COUNTY RADIATION ONCOLOGY, SC
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Dates
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Enumeration Date | 04/01/2009
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Last Update Date | 04/16/2009
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Provider Practice Location Address
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Address Line | 7531 S STONY ISLAND AVE BASEMENT
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City | CHICAGO
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State | IL
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Zip | 60649-3954
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Country | US
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Telephone | 773-947-7850
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Fax | 773-947-7852
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Provider Business Mailing Address
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Address Line | 3400 N LAKE SHORE DR UNIT 9-B
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City | CHICAGO
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State | IL
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Zip | 60657-2827
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Country | US
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Telephone | 773-947-7850
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Fax | 773-947-7852
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Authorized Official
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Title or Position | CHAIRMAN
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Name | NATHANIEL O. HOLLOWAY
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Credential | MD
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Telephone | 773-947-7850
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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 | 036-073542
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License Number State | IL
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