Provider Demographics
NPI:1083663603
Name:CARDIOLOGY INTERPRETATION OF JOLIET
Entity Type:Organization
Organization Name:CARDIOLOGY INTERPRETATION OF JOLIET
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:KILLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-740-1900
Mailing Address - Street 1:2801 BLACK RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-2929
Mailing Address - Country:US
Mailing Address - Phone:815-740-1900
Mailing Address - Fax:815-725-2413
Practice Address - Street 1:2801 BLACK RD
Practice Address - Street 2:SUITE A
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-2929
Practice Address - Country:US
Practice Address - Phone:815-740-1900
Practice Address - Fax:815-725-2413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042066110207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL749850Medicare UPIN