Provider Demographics
NPI:1508813403
Name:CARDIAC IMAGING CENTERS OF AMERICA
Entity Type:Organization
Organization Name:CARDIAC IMAGING CENTERS OF AMERICA
Other - Org Name:HEART SCAN OF CHICAGO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:DESNICK
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:312-587-1111
Mailing Address - Street 1:100 E WALTON ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-1448
Mailing Address - Country:US
Mailing Address - Phone:312-587-1111
Mailing Address - Fax:312-587-1110
Practice Address - Street 1:100 E WALTON ST
Practice Address - Street 2:SUITE 106
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-1448
Practice Address - Country:US
Practice Address - Phone:312-587-1111
Practice Address - Fax:312-587-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty