Provider Demographics
NPI:1144523895
Name:CDH CANCER CENTER
Entity type:Organization
Organization Name:CDH CANCER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, FINANCE AND CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-933-6342
Mailing Address - Street 1:0N025 WINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1237
Mailing Address - Country:US
Mailing Address - Phone:630-933-1600
Mailing Address - Fax:630-933-2766
Practice Address - Street 1:4405 WEAVER PKWY
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-3269
Practice Address - Country:US
Practice Address - Phone:630-352-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL DUPAGE HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL000000216261QI0500X, 261QR0200X, 261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========401Medicaid
140242Medicare PIN