Organization
ILLINOIS REGIONAL CANCER CENTER LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BHARATI D. BHATE MD (MEDICAL DIRECTOR)
(815) 756-4722
Entity
Organization
Contact information
Practice address
10 HEALTH SERVICES DR, DEKALB, IL 60115-9637
(815) 756-4722
(815) 756-4046
Mailing address
PO BOX 723, DEKALB, IL 60115-0723
(815) 756-4722
(815) 756-4046
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036-061312
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-061312
—
IL
01
—
1962496034
PROVIDER NPI NUMBER
IL
Enumeration date
02/13/2007
Last updated
08/05/2015
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