Provider Demographics
NPI:1629690185
Name:ILLINOIS RADIATION ONCOLOGY CONSULTANTS PLLC
Entity Type:Organization
Organization Name:ILLINOIS RADIATION ONCOLOGY CONSULTANTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUDD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-324-1100
Mailing Address - Street 1:PO BOX 483
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62056-0483
Mailing Address - Country:US
Mailing Address - Phone:217-324-1100
Mailing Address - Fax:217-324-1103
Practice Address - Street 1:208 FLAX DR STE 100
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:62249-1396
Practice Address - Country:US
Practice Address - Phone:618-882-5621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-07
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty