Provider Demographics
NPI:1356664742
Name:AMIRY CARDIOLOGY CONSULTANT MD SC
Entity Type:Organization
Organization Name:AMIRY CARDIOLOGY CONSULTANT MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:AMIRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:224-848-4353
Mailing Address - Street 1:102A FOX GLEN CT
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-1805
Mailing Address - Country:US
Mailing Address - Phone:224-848-4353
Mailing Address - Fax:224-848-4356
Practice Address - Street 1:102A FOX GLEN CT
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-1805
Practice Address - Country:US
Practice Address - Phone:224-848-4353
Practice Address - Fax:224-848-4356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-12
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036054225207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL3566Medicare PIN
ILDR2684Medicare PIN
ILDQ4997Medicare PIN
ILIL3565Medicare PIN