Provider Demographics
NPI:1437394590
Name:CHRISTY CARDIOLOGY LTD
Entity Type:Organization
Organization Name:CHRISTY CARDIOLOGY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CHRISTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:224-357-8133
Mailing Address - Street 1:4400 W 95TH ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2654
Mailing Address - Country:US
Mailing Address - Phone:224-357-8133
Mailing Address - Fax:224-357-8048
Practice Address - Street 1:912 NORTHWEST HWY
Practice Address - Street 2:SUITE 4
Practice Address - City:FOX RIVER GROVE
Practice Address - State:IL
Practice Address - Zip Code:60021-1925
Practice Address - Country:US
Practice Address - Phone:224-357-8133
Practice Address - Fax:224-357-8048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042619401207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL042619401Medicaid
IL1437394590Medicaid
IL0001628870OtherBLUECROSSBLUESHIELD
IN200940650AMedicaid
IN200940650BMedicaid
IN200940650BMedicaid
IL042619401Medicaid
IN200940650AMedicaid
ILD07664Medicare PIN