Provider Demographics
NPI:1033304571
Name:HEART SPECIALIST, LTD
Entity Type:Organization
Organization Name:HEART SPECIALIST, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHISH
Authorized Official - Middle Name:
Authorized Official - Last Name:MUKHERJEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-657-0825
Mailing Address - Street 1:2415 HALINA DR
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1196
Mailing Address - Country:US
Mailing Address - Phone:847-899-1701
Mailing Address - Fax:
Practice Address - Street 1:4900 S ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-3663
Practice Address - Country:US
Practice Address - Phone:773-767-8375
Practice Address - Fax:773-767-8532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL907490Medicare PIN