Provider Demographics
NPI:1487684395
Name:NORTHWEST INDIANA RADIATION ONCOLOGY, PC
Entity Type:Organization
Organization Name:NORTHWEST INDIANA RADIATION ONCOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:WAHEED
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-757-6285
Mailing Address - Street 1:PO BOX 226
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-0226
Mailing Address - Country:US
Mailing Address - Phone:708-482-4949
Mailing Address - Fax:708-482-4949
Practice Address - Street 1:1201 MAIN ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-2716
Practice Address - Country:US
Practice Address - Phone:708-482-4949
Practice Address - Fax:708-482-4949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ01030584A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100188320AMedicaid
IN100188320AMedicaid