Provider Demographics
NPI:1548251986
Name:ADVANCED RADIATION ONCOLOGY CENTER OF ILLINOIS INC
Entity type:Organization
Organization Name:ADVANCED RADIATION ONCOLOGY CENTER OF ILLINOIS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:YASHBIR
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-623-2114
Mailing Address - Street 1:PO BOX 379
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-0379
Mailing Address - Country:US
Mailing Address - Phone:708-460-9833
Mailing Address - Fax:708-460-1117
Practice Address - Street 1:95 N GREENLEAF ST
Practice Address - Street 2:SUITE A
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3309
Practice Address - Country:US
Practice Address - Phone:847-623-2114
Practice Address - Fax:847-623-4628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL97120OtherPARVATHY KURUP, MD - MDCR
ILL97119OtherYASHBIR MEHTA, MD - MDCR
IL204949Medicare PIN