Basic Information
| Provider Information | |||||||||
| NPI: | 1194994582 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CANCER CARE GROUP, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6100 W 96TH ST | ||||||||
| Address2: | SUITE 125 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462786005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177151800 | ||||||||
| FaxNumber: | 3177156200 | ||||||||
| Practice Location | |||||||||
| Address1: | 275 W 12TH ST | ||||||||
| Address2: | |||||||||
| City: | PERU | ||||||||
| State: | IN | ||||||||
| PostalCode: | 469701638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7654736621 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/29/2008 | ||||||||
| LastUpdateDate: | 02/29/2008 | ||||||||
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| AuthorizedOfficialLastName: | DUGAN | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3177151800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 50004183A | IN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.