1982436507 NPI number — HEART AND VASCULAR SPECIALISTS LLC

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 1982436507 NPI number — HEART AND VASCULAR SPECIALISTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEART AND VASCULAR SPECIALISTS LLC
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:
1982436507
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2045 W GRAND AVE STE B713681
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60612-1576
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-529-7109
Provider Business Mailing Address Fax Number:
708-741-3025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10378 SOUTH . HARLEM AVE
Provider Second Line Business Practice Location Address:
CARDIOVASCULAR SUITE
Provider Business Practice Location Address City Name:
PALOS HILLS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60465
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-925-7109
Provider Business Practice Location Address Fax Number:
708-741-3025
Provider Enumeration Date:
08/14/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AHDAB
Authorized Official First Name:
TAREK
Authorized Official Middle Name:
MOHAMAD
Authorized Official Title or Position:
PRESIDENT-EMPLOYEE
Authorized Official Telephone Number:
708-529-7109

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207UN0901X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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