Provider Demographics
NPI:1477793073
Name:CARDIO PULMONARY ASSOCIATES INC
Entity Type:Organization
Organization Name:CARDIO PULMONARY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WALDEMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:CHODAKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-384-4494
Mailing Address - Street 1:2923 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-7404
Mailing Address - Country:US
Mailing Address - Phone:773-384-4494
Mailing Address - Fax:773-384-4422
Practice Address - Street 1:2923 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-7404
Practice Address - Country:US
Practice Address - Phone:773-384-4494
Practice Address - Fax:773-384-4422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL194-003475261QS1200X
IL203-000235332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635008OtherBLUE SHIELD OF IL
IL01635008OtherBLUE SHIELD OF IL
IL=========01Medicaid