Provider Demographics
NPI:1114177508
Name:KISHWAUKEE CARDIOLOGY ASSOCIATES, LTD
Entity Type:Organization
Organization Name:KISHWAUKEE CARDIOLOGY ASSOCIATES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAGDISH
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACC
Authorized Official - Phone:815-786-7076
Mailing Address - Street 1:2530 HAUSER ROSS DR
Mailing Address - Street 2:STE 100
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3162
Mailing Address - Country:US
Mailing Address - Phone:815-748-7076
Mailing Address - Fax:815-748-7070
Practice Address - Street 1:2550 HAUSER ROSS DR STE 100
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3149
Practice Address - Country:US
Practice Address - Phone:815-786-7076
Practice Address - Fax:815-786-7379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL035090465Medicaid
IL01932095OtherBLUE CROSS BLUE SHIELD- IL
IL035090465Medicaid