1285785238 NPI number — SUBURBAN CARDIOLOGISTS, S.C.

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 1285785238 NPI number — SUBURBAN CARDIOLOGISTS, S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUBURBAN CARDIOLOGISTS, S.C.
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:
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:
1285785238
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 CHESTNUT ST
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
HINSDALE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60521-3247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-325-9010
Provider Business Mailing Address Fax Number:
630-325-9023

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5101 S WILLOW SPRING ROAD
Provider Second Line Business Practice Location Address:
SUITE 160
Provider Business Practice Location Address City Name:
LA GRANGE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-325-9010
Provider Business Practice Location Address Fax Number:
630-325-9023
Provider Enumeration Date:
01/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
630-325-9010

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  042003338 , 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)





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