Provider Demographics
NPI:1093931032
Name:CARDIOVASCULAR ASSOCIATES OF GLENBROOK AND EVANSTON
Entity Type:Organization
Organization Name:CARDIOVASCULAR ASSOCIATES OF GLENBROOK AND EVANSTON
Other - Org Name:CAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRWIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SILVERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-869-1499
Mailing Address - Street 1:1713 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1507
Mailing Address - Country:US
Mailing Address - Phone:847-869-1499
Mailing Address - Fax:847-869-2932
Practice Address - Street 1:1713 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1507
Practice Address - Country:US
Practice Address - Phone:847-869-1499
Practice Address - Fax:847-869-2932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL202886173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632521OtherBC/BS #
IL202886OtherILLINOIS MEDICARE B
IL202886Medicare PIN