Provider Demographics
NPI:1093763500
Name:OAK PARK CARDIOLOGY, S.C.
Entity Type:Organization
Organization Name:OAK PARK CARDIOLOGY, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AIDE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-488-1122
Mailing Address - Street 1:7411 LAKE ST
Mailing Address - Street 2:STE 2110
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1876
Mailing Address - Country:US
Mailing Address - Phone:708-488-1122
Mailing Address - Fax:708-488-1142
Practice Address - Street 1:7411 LAKE ST
Practice Address - Street 2:STE 2110
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1876
Practice Address - Country:US
Practice Address - Phone:708-488-1122
Practice Address - Fax:708-488-1142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
208436Medicare PIN