Provider Demographics
NPI:1154369643
Name:RADIATION ONCOLOGY, S.C.
Entity type:Organization
Organization Name:RADIATION ONCOLOGY, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SYED JAVED
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIRAZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-448-9393
Mailing Address - Street 1:17333 LA GRANGE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-7510
Mailing Address - Country:US
Mailing Address - Phone:708-748-9918
Mailing Address - Fax:708-448-7530
Practice Address - Street 1:17333 LA GRANGE RD STE 100
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-7510
Practice Address - Country:US
Practice Address - Phone:708-748-9918
Practice Address - Fax:708-448-7530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0420023972085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1615960OtherBLUE CROSS & BLUE SHIELD
ILCM3238OtherPALMETTO GBA-RR MEDICARE
IL611370Medicare PIN