Provider Demographics
NPI:1184655276
Name:CARDIO MEDICAL CENTER SC
Entity Type:Organization
Organization Name:CARDIO MEDICAL CENTER SC
Other - Org Name:RIAZ A AKHTAR
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER MD
Authorized Official - Prefix:DR
Authorized Official - First Name:RIAZ
Authorized Official - Middle Name:A
Authorized Official - Last Name:AKHTAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACC
Authorized Official - Phone:630-629-6700
Mailing Address - Street 1:1 SOUTH 085 SUMMIT AVENUE
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181
Mailing Address - Country:US
Mailing Address - Phone:630-629-9700
Mailing Address - Fax:630-629-1888
Practice Address - Street 1:1 SOUTH 085 SUMMIT AVENUE
Practice Address - Street 2:
Practice Address - City:OAK BROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181
Practice Address - Country:US
Practice Address - Phone:630-629-9700
Practice Address - Fax:630-629-1888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1L00336477611207R00000X, 207RC0000X
IL036047761332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036047761Medicaid
IL000900130OtherBC
IL060016608OtherRAILROAD
IL2215715OtherBC
IL000900130OtherBC
IL222050Medicare ID - Type Unspecified
IL222051Medicare ID - Type Unspecified