Organization
NORTHERN ILLINOIS CANCER TREATMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JON BERENS (AUTHORIZED OFFICIAL)
(815) 284-1111
Entity
Organization
Contact information
Practice address
327 IL ROUTE 2, DIXON, IL 61021-9118
(815) 284-1111
(815) 284-2306
Mailing address
327 IL ROUTE 2, DIXON, IL 61021-9118
(815) 284-1111
(815) 284-2306
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05215222
BLUE SHIELD PROVIDER NUMB
IL
Enumeration date
07/26/2005
Last updated
01/02/2024
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