Provider Demographics
NPI:1073905311
Name:CARDIO MEDICAL CENTER SC
Entity Type:Organization
Organization Name:CARDIO MEDICAL CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RIAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:AKHTAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-710-6020
Mailing Address - Street 1:7746 WEST MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:FORREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60131
Mailing Address - Country:US
Mailing Address - Phone:708-488-0392
Mailing Address - Fax:708-488-0393
Practice Address - Street 1:7746 WEST MADISON AVE
Practice Address - Street 2:
Practice Address - City:FORREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60131
Practice Address - Country:US
Practice Address - Phone:708-488-0392
Practice Address - Fax:708-488-0393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-24
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036047761207RC0000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7327420001Medicare NSC