NPIMap

Organization Active NPI

Radiation Oncology Associates of Michiana PC

  • Radiation Oncology Physician
  • South Bend, IN
National Provider Identifier
1073569174
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
Legal business name
RADIATION ONCOLOGY ASSOCIATES OF MICHIANA PC
Practice address
707 Cedar St
South Bend, IN 46617-2054
Phone
(574) 271-2558
Fax
(574) 273-1137
NPI assigned
May 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Guy Kedziora, MDNPI 1619977543
Title
President
Phone
(574) 237-8000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0001X Primary

Addresses

Primary practice location

707 Cedar St
South Bend, IN 46617-2054

Mailing address

707 Cedar St
South Bend, IN 46617-2054

National Provider Directory

National Provider Directory
Tax ID family
Radiation Oncology Associates of Michiana PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

707 Cedar St
Ste 100
South Bend, IN 46617
Phone (574) 237-8007

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1073569174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 CEDAR ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 CEDAR ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172054",
            "telephone_number": "574-271-2558",
            "fax_number": "574-273-1137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIATION ONCOLOGY ASSOCIATES OF MICHIANA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KEDZIORA",
        "authorized_official_first_name": "GUY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "574-237-8000",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Radiation Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.