Provider Demographics
NPI:1518032739
Name:ILLINOIS INSTITUTE OF PEDIATRIC CARDIOLOGY
Entity Type:Organization
Organization Name:ILLINOIS INSTITUTE OF PEDIATRIC CARDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHMET
Authorized Official - Middle Name:
Authorized Official - Last Name:GULECYUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-531-0001
Mailing Address - Street 1:1202N 75TH ST
Mailing Address - Street 2:STE 270
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-4274
Mailing Address - Country:US
Mailing Address - Phone:331-222-7676
Mailing Address - Fax:630-527-2727
Practice Address - Street 1:1202N 75TH ST
Practice Address - Street 2:STE 270
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-4274
Practice Address - Country:US
Practice Address - Phone:331-222-7676
Practice Address - Fax:630-527-2727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0426189192080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty