Provider Demographics
NPI:1598937054
Name:RADIATION MEDICINE INSTITUTE
Entity Type:Organization
Organization Name:RADIATION MEDICINE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOOMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-570-2590
Mailing Address - Street 1:9818 EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60678-0001
Mailing Address - Country:US
Mailing Address - Phone:630-285-1530
Mailing Address - Fax:630-285-1490
Practice Address - Street 1:2650 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1718
Practice Address - Country:US
Practice Address - Phone:847-570-2590
Practice Address - Fax:847-570-1878
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE RADIATION MEDICINE INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-25
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL573640Medicare PIN