Provider Demographics
NPI:1245496025
Name:COON, ALAN BLAINE (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:BLAINE
Last Name:COON
Suffix:
Gender:M
Credentials:MD, PHD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:875 WHITE HAWK DR
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-2685
Mailing Address - Country:US
Mailing Address - Phone:708-366-4587
Mailing Address - Fax:
Practice Address - Street 1:200 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-4689
Practice Address - Country:US
Practice Address - Phone:815-929-0010
Practice Address - Fax:815-929-0014
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01067843A2085R0001X
IL1250489062085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology