Basic Information
| Provider Information | |||||||||
| NPI: | 1548251986 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED RADIATION ONCOLOGY CENTER OF ILLINOIS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 379 | ||||||||
| Address2: | |||||||||
| City: | ORLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604620379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084609833 | ||||||||
| FaxNumber: | 7084601117 | ||||||||
| Practice Location | |||||||||
| Address1: | 95 N GREENLEAF ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | GURNEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600313309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476232114 | ||||||||
| FaxNumber: | 8476234628 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2005 | ||||||||
| LastUpdateDate: | 05/03/2019 | ||||||||
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| AuthorizedOfficialLastName: | MEHTA | ||||||||
| AuthorizedOfficialFirstName: | YASHBIR | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8476232114 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | L97120 | 01 | IL | PARVATHY KURUP, MD - MDCR | OTHER | L97119 | 01 | IL | YASHBIR MEHTA, MD - MDCR | OTHER |