Provider Demographics
NPI:1417908765
Name:MIDWEST HEART SPECIALISTS, LTD
Entity Type:Organization
Organization Name:MIDWEST HEART SPECIALISTS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:MAREK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-719-4799
Mailing Address - Street 1:1919 S HIGHLAND AVE
Mailing Address - Street 2:SUITE B202
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6153
Mailing Address - Country:US
Mailing Address - Phone:630-268-1102
Mailing Address - Fax:630-268-1125
Practice Address - Street 1:3825 HIGHLAND AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1552
Practice Address - Country:US
Practice Address - Phone:630-719-4999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02215038OtherBCBS
IL200251Medicare ID - Type UnspecifiedGROUP ID#
IL02215038OtherBCBS
IL602930Medicare ID - Type UnspecifiedGROUP ID #
IL202211Medicare ID - Type UnspecifiedGROUP ID #
IL205080Medicare ID - Type UnspecifiedGROUP ID#
IL202209Medicare ID - Type UnspecifiedGROUP ID #