Provider Demographics
NPI:1124399605
Name:SOUTH SUBURBAN CARDIOLOGY ASSOCIATES, LTD.
Entity Type:Organization
Organization Name:SOUTH SUBURBAN CARDIOLOGY ASSOCIATES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERDKIAT
Authorized Official - Middle Name:
Authorized Official - Last Name:SANGKAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-748-9952
Mailing Address - Street 1:3800 W 203RD ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1184
Mailing Address - Country:US
Mailing Address - Phone:708-748-9952
Mailing Address - Fax:708-748-9924
Practice Address - Street 1:20303 S CRAWFORD AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1176
Practice Address - Country:US
Practice Address - Phone:708-481-5500
Practice Address - Fax:708-481-8381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-16
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1124399605OtherGROUP NPI
IL1124399605OtherBCBS