Provider Demographics
NPI:1164530713
Name:CONSULTANTS IN CARDIOVASCULAR MEDICINE, S. C.
Entity Type:Organization
Organization Name:CONSULTANTS IN CARDIOVASCULAR MEDICINE, S. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:G
Authorized Official - Last Name:SHANES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-838-1448
Mailing Address - Street 1:675 W NORTH AVENUE
Mailing Address - Street 2:SUITE-210
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-1634
Mailing Address - Country:US
Mailing Address - Phone:708-838-1448
Mailing Address - Fax:708-344-0508
Practice Address - Street 1:675 W NORTH AVENUE
Practice Address - Street 2:SUITE-210
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1634
Practice Address - Country:US
Practice Address - Phone:708-838-1448
Practice Address - Fax:708-344-0508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-064782174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL479-70-6233001Medicaid
IL036-064782Medicaid
IL961280OtherMEDICARE
ILCC1592OtherMEDICARE RAILROAD
IL478-94-8068001Medicaid
IL036-104771Medicaid
IL216577OtherMEDICARE LOCALITY 015 GROUP PTAN NUMBER
IL31602469OtherBCBS