Organization
INTER-COMMUNITY RADIATION ONCOLOGY SC
Active
Other names
South Suburban Cancer Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAYANT V GINDE MD (OFFICER)
(708) 799-9995
Entity
Organization
Contact information
Practice address
17750 KEDZIE AVE, HAZEL CREST, IL 60429-2047
(708) 799-9995
(708) 799-8129
Mailing address
PO BOX 15040, EVANSVILLE, IN 47716-0040
(812) 962-6413
(812) 471-9282
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0031603263
BCBS OF IL
IL
01
—
CM3780
RR MEDICARE GROUP #
IL
Enumeration date
11/11/2005
Last updated
06/20/2008
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