Provider Demographics
NPI:1659449163
Name:PEDIATRIC CANCER INSTITUTE
Entity Type:Organization
Organization Name:PEDIATRIC CANCER INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHARAD
Authorized Official - Middle Name:N
Authorized Official - Last Name:SALVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-684-4094
Mailing Address - Street 1:4440 W.95TH STREET
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453
Mailing Address - Country:US
Mailing Address - Phone:708-684-4094
Mailing Address - Fax:708-684-5141
Practice Address - Street 1:4440 W.95TH STREET
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453
Practice Address - Country:US
Practice Address - Phone:708-684-4094
Practice Address - Fax:708-684-5141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01620238OtherBC-BS GROUP PROVIDER NUMB
ILD14860Medicare UPIN
IL685011Medicare ID - Type Unspecified