Provider Demographics
NPI:1487606315
Name:CHICAGO RADIATION ONCOLOGY, S.C.
Entity type:Organization
Organization Name:CHICAGO RADIATION ONCOLOGY, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:MOHAMMAD
Authorized Official - Last Name:AMEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-842-7309
Mailing Address - Street 1:609 SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:IL
Mailing Address - Zip Code:60022-1742
Mailing Address - Country:US
Mailing Address - Phone:312-842-7309
Mailing Address - Fax:312-842-7491
Practice Address - Street 1:2839 S ELLIS AVE
Practice Address - Street 2:MR-148
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2906
Practice Address - Country:US
Practice Address - Phone:312-842-9600
Practice Address - Fax:312-842-9679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360451362085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC42583/F19584/D88651Medicare UPIN
IL921520Medicare ID - Type Unspecified