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General NPI Number Information
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NPI Number | 1649343864
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Entity Type | Organization
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Legal Business Name | ILLINOIS CANCER SPECIALISTS
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 8915 W GOLF RD
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City | NILES
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State | IL
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Zip | 60714-5905
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Country | US
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Telephone | 847-954-3480
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Fax | 847-827-1574
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Provider Business Mailing Address
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Address Line | 25070 NETWORK PL
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City | CHICAGO
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State | IL
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Zip | 60673-1250
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Country | US
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Telephone | 847-585-7000
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Fax | 847-240-0622
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Authorized Official
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Title or Position | NETWORK CONTRACTING REPRESENTATIVE
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Name | RIA DALMACIO
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Credential |
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Telephone | 312-520-4757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 054014868
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License Number State | IL
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