Provider Demographics
NPI:1659568764
Name:ILLINOIS ONCOLOGY LTD
Entity Type:Organization
Organization Name:ILLINOIS ONCOLOGY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:POPOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-288-6800
Mailing Address - Street 1:4000 NORTH ILLINOIS LANE
Mailing Address - Street 2:SUITE C
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226
Mailing Address - Country:US
Mailing Address - Phone:618-233-8000
Mailing Address - Fax:618-233-8070
Practice Address - Street 1:4000 NORTH ILLINOIS LANE
Practice Address - Street 2:SUITE C
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226
Practice Address - Country:US
Practice Address - Phone:618-233-8000
Practice Address - Fax:618-233-8020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3870480003Medicare NSC