Provider Demographics
NPI:1861473704
Name:JAIDEV SONI
Entity Type:Organization
Organization Name:JAIDEV SONI
Other - Org Name:DANVILLE CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIDEV
Authorized Official - Middle Name:C
Authorized Official - Last Name:SONI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-774-2970
Mailing Address - Street 1:PO BOX 379
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-0379
Mailing Address - Country:US
Mailing Address - Phone:708-774-2970
Mailing Address - Fax:708-460-1117
Practice Address - Street 1:806 N LOGAN AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-3716
Practice Address - Country:US
Practice Address - Phone:217-431-4290
Practice Address - Fax:217-431-4013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9200217OtherBCBS IL GR #
IL669160Medicare ID - Type Unspecified