1023233731 NPI number — CARDIOVASCULAR ASSOCIATES OF GLENBROOK AND EVANSTON

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023233731 NPI number — CARDIOVASCULAR ASSOCIATES OF GLENBROOK AND EVANSTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIOVASCULAR ASSOCIATES OF GLENBROOK AND EVANSTON
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023233731
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2501 COMPASS ROAD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
GLENVIEW
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-869-1499
Provider Business Mailing Address Fax Number:
847-901-5250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2501 COMPASS RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
GLENVIEW
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60026-8000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-869-1499
Provider Business Practice Location Address Fax Number:
847-901-5250
Provider Enumeration Date:
04/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SILVERMAN
Authorized Official First Name:
IRWIN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
847-869-1499

Provider Taxonomy Codes

  • Taxonomy code: 173000000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01632521 . This is a "ILLINOIS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1720042419 . This is a "NPI OF OTHER LOCATION" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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