Provider Demographics
NPI:1376649319
Name:WICKER PARK HEART SPECIALISTS, LLC
Entity Type:Organization
Organization Name:WICKER PARK HEART SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANILO
Authorized Official - Middle Name:ANGELES
Authorized Official - Last Name:DEANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-292-9791
Mailing Address - Street 1:2222 W DIVISION ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2717
Mailing Address - Country:US
Mailing Address - Phone:773-292-9791
Mailing Address - Fax:773-292-9792
Practice Address - Street 1:2222 W DIVISION ST
Practice Address - Street 2:SUITE 300
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2717
Practice Address - Country:US
Practice Address - Phone:773-292-9791
Practice Address - Fax:773-292-9792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1630322OtherBCBS IL
CJ3188OtherRAILROAD MEDICARE
CJ3188OtherRAILROAD MEDICARE