Provider Demographics
NPI:1477575504
Name:VALLEY MEDICAL & CARDIAC CLINIC, LTD.
Entity Type:Organization
Organization Name:VALLEY MEDICAL & CARDIAC CLINIC, LTD.
Other - Org Name:VALLEY MEDICAL & CARDIAC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-888-2557
Mailing Address - Street 1:87 N AIRLITE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4988
Mailing Address - Country:US
Mailing Address - Phone:847-888-2557
Mailing Address - Fax:847-888-2591
Practice Address - Street 1:87 N. AIRLITE STTREET
Practice Address - Street 2:SUITE 100
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5879
Practice Address - Country:US
Practice Address - Phone:847-888-2557
Practice Address - Fax:847-888-2591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty