Provider Demographics
NPI:1124375274
Name:BLOCK, ALEC
Entity type:Individual
Prefix:
First Name:ALEC
Middle Name:
Last Name:BLOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 SOUTH FIRST AVE
Mailing Address - Street 2:LOYOLA RADATION ONCOLOGY
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-216-2729
Mailing Address - Fax:708-216-5924
Practice Address - Street 1:2160 SOUTH FIRST AVE
Practice Address - Street 2:LOYOLA RADATION ONCOLOGY
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-216-2729
Practice Address - Fax:708-216-5924
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1250618782085R0001X
IL0361426382085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology