Provider Demographics
NPI:1497704514
Name:CARDIOSPECIALISTS GROUP, LTD
Entity Type:Organization
Organization Name:CARDIOSPECIALISTS GROUP, LTD
Other - Org Name:MIDWEST ARRHYTHMIA CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:L
Authorized Official - Last Name:SUPRENANT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:219-319-0300
Mailing Address - Street 1:39649 TREASURY CTR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60694-9000
Mailing Address - Country:US
Mailing Address - Phone:219-319-0300
Mailing Address - Fax:219-440-7475
Practice Address - Street 1:2150 GETTLER ST
Practice Address - Street 2:SUITE 122
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-2380
Practice Address - Country:US
Practice Address - Phone:219-319-0300
Practice Address - Fax:219-440-7475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCN0895OtherRR MEDICARE
INCA4855OtherRR MEDICARE
ILDA0548OtherRR MEDICARE
IL204424Medicare PIN
IN406310Medicare PIN
INCA4855OtherRR MEDICARE