Provider Demographics
NPI:1518945989
Name:ADVANCED HEART GROUP SC
Entity Type:Organization
Organization Name:ADVANCED HEART GROUP SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT ADANCED HEART GROUP SC
Authorized Official - Prefix:DR
Authorized Official - First Name:PONNAMBALAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:SUNDRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-331-2200
Mailing Address - Street 1:71 W 156TH ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426
Mailing Address - Country:US
Mailing Address - Phone:708-331-2200
Mailing Address - Fax:708-331-8015
Practice Address - Street 1:71 W 156TH ST
Practice Address - Street 2:SUITE 305
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426
Practice Address - Country:US
Practice Address - Phone:708-331-2200
Practice Address - Fax:708-331-8015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty