Provider Demographics
NPI:1720141047
Name:FOX VALLEY RADIATION ONCOLOGY LLC
Entity Type:Organization
Organization Name:FOX VALLEY RADIATION ONCOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:VASUDHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LINGAREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-646-6161
Mailing Address - Street 1:1005 SHERINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-6111
Mailing Address - Country:US
Mailing Address - Phone:630-357-4286
Mailing Address - Fax:630-416-4741
Practice Address - Street 1:120 SPALDING DR
Practice Address - Street 2:SUITE 111
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6508
Practice Address - Country:US
Practice Address - Phone:630-646-6161
Practice Address - Fax:630-646-6165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2233109OtherBLUE CROSS BLUE SHIELD
IL2233109OtherBLUE CROSS BLUE SHIELD