Provider Demographics
NPI:1932154754
Name:RADIATION ONCOLOGY ASSOCIATES, LTD
Entity Type:Organization
Organization Name:RADIATION ONCOLOGY ASSOCIATES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BASTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-649-6420
Mailing Address - Street 1:11516 N PORT WASHINGTON RD
Mailing Address - Street 2:STE 107
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3441
Mailing Address - Country:US
Mailing Address - Phone:262-241-5040
Mailing Address - Fax:262-241-5261
Practice Address - Street 1:2900 W OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4330
Practice Address - Country:US
Practice Address - Phone:414-649-6420
Practice Address - Fax:414-649-5309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32741900Medicaid
WI000060310Medicare ID - Type UnspecifiedSHEBOYGAN
WI000001331Medicare ID - Type UnspecifiedMILWAUKEE
WI000007805Medicare ID - Type UnspecifiedGREEN BAY
WI32741900Medicaid