Provider Demographics
NPI:1326574245
Name:CARDIOVASCULAR CONSULTANTS OF AURORA, S.C.
Entity Type:Organization
Organization Name:CARDIOVASCULAR CONSULTANTS OF AURORA, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABBAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHAWAJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-264-3250
Mailing Address - Street 1:11 N EDGELAWN DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-4362
Mailing Address - Country:US
Mailing Address - Phone:630-264-3250
Mailing Address - Fax:
Practice Address - Street 1:11 N EDGELAWN DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506
Practice Address - Country:US
Practice Address - Phone:630-264-3250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036046187207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU11008Medicare UPIN