1972665990 NPI number — CARDIOVASCULAR CONSULTANTS OF NAPERVILLE, LTD.

Table of content: (NPI 1972665990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972665990 NPI number — CARDIOVASCULAR CONSULTANTS OF NAPERVILLE, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIOVASCULAR CONSULTANTS OF NAPERVILLE, LTD.
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:
1972665990
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 SPALDING DR
Provider Second Line Business Mailing Address:
SUITE 212
Provider Business Mailing Address City Name:
NAPERVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60540-6550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-357-4111
Provider Business Mailing Address Fax Number:
630-357-4644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 SPALDING DR
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
NAPERVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60540-6550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-357-4111
Provider Business Practice Location Address Fax Number:
630-357-4644
Provider Enumeration Date:
12/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OSTRENGA
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
630-357-4111

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  042006369 , 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: 036110817 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1801983648 . This is a "NPI-JAMES P. OSTRENGA, MD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036057460 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1265525729 . This is a "NPI - MARK R. OTTOLIN,MD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 2215535 . This is a "BCBSOF IL PROVIDER NUMB" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036064112 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1588750327 . This is a "NPI-SHARON L. CLINE, M.D." identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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