Provider Demographics
NPI:1053491084
Name:CARDIOMEDIX INCORPORATED
Entity Type:Organization
Organization Name:CARDIOMEDIX INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ZIPORA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-869-0230
Mailing Address - Street 1:1840 OAK AVE
Mailing Address - Street 2:SUITE 218
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3642
Mailing Address - Country:US
Mailing Address - Phone:847-869-0230
Mailing Address - Fax:
Practice Address - Street 1:2800 S RIVER RD STE 420
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-6087
Practice Address - Country:US
Practice Address - Phone:847-869-0230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036051641Medicaid
IL4461000OtherAETNA
IL1632474OtherBLUE CROSS BLUE SHIELD
IL036051641Medicaid