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NPI Code Detail

MEDICARE: RADIATION ONCOLOGY, S.C.

MEDICARE: RADIATION ONCOLOGY, S.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0001XRadiation Oncology Physician042002397IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2CM3238OTHERILPALMETTO GBA-RR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11615960OTHERILBLUE CROSS & BLUE SHIELD

General Provider Information

NPI Number : 1154369643
Entity Type Code : Organization
Provider Name (Legal Business Name) : RADIATION ONCOLOGY, S.C.
Provider Business Mailing Address
First Line : 17333 LA GRANGE RD STE 100
Second Line :
City : TINLEY PARK
State : IL
Zip : 60487-7510
Country : US
Telephone Number : 708-748-9918
Fax Number : 708-448-7530
Provider Business Practice Location Address
First Line : 17333 LA GRANGE RD STE 100
Second Line :
City : TINLEY PARK
State : IL
Zip : 60487-7510
Country : US
Telephone Number : 708-748-9918
Fax Number : 708-448-7530
Authorized Official
Title or Position : PRESIDENT
Name : SYED JAVED SHIRAZI
Credential : M.D.
Telephone Number : 708-448-9393
Provider Enumeration Date : 06/04/2006
Last Update Date : 05/24/2019

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Directions to “RADIATION ONCOLOGY, S.C. ” Practice Location

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