Provider Demographics
NPI:1407953607
Name:CARDIOLOGY AND VASCULAR SPECIALISTS, LLC
Entity Type:Organization
Organization Name:CARDIOLOGY AND VASCULAR SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD./OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOU
Authorized Official - Middle Name:V
Authorized Official - Last Name:IVANOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACC
Authorized Official - Phone:708-488-1010
Mailing Address - Street 1:7035 W. NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302
Mailing Address - Country:US
Mailing Address - Phone:708-488-1010
Mailing Address - Fax:708-488-1420
Practice Address - Street 1:7035 W. NORTH AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302
Practice Address - Country:US
Practice Address - Phone:708-488-1010
Practice Address - Fax:708-488-1420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RC0000X
IL207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL362985685Medicaid
IL36073485Medicaid
IL36073485Medicaid