1235277203 NPI number — BARRINGTON CARDIOLOGY SC

Table of content: (NPI 1235277203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235277203 NPI number — BARRINGTON CARDIOLOGY SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARRINGTON CARDIOLOGY SC
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:
CRYSTAL LAKE CARDIOLOGY
Provider Other Organization Name Type Code:
3
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:
1235277203
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
912 W NORTHWEST HWY
Provider Second Line Business Mailing Address:
#100
Provider Business Mailing Address City Name:
FOX RIVER GROVE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-516-2424
Provider Business Mailing Address Fax Number:
847-750-0390

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
912 NORTHWEST HWY
Provider Second Line Business Practice Location Address:
#100
Provider Business Practice Location Address City Name:
FOX RIVER GROVE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60021-1925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-516-2424
Provider Business Practice Location Address Fax Number:
847-750-0390
Provider Enumeration Date:
02/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KADAKIA
Authorized Official First Name:
SUNIL
Authorized Official Middle Name:
N
Authorized Official Title or Position:
MD PRESIDENT
Authorized Official Telephone Number:
847-516-2424

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , 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: 05625392 . This is a "BC" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: DE1026 . This is a "RR MC" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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