Provider Demographics
NPI:1518978923
Name:MIDWEST CARDIAC CENTER SC
Entity Type:Organization
Organization Name:MIDWEST CARDIAC CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFIICAL
Authorized Official - Prefix:
Authorized Official - First Name:GOPAL
Authorized Official - Middle Name:
Authorized Official - Last Name:LALMALANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-792-0900
Mailing Address - Street 1:PO BOX 3461
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60522-3461
Mailing Address - Country:US
Mailing Address - Phone:773-884-3300
Mailing Address - Fax:
Practice Address - Street 1:6441 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-5148
Practice Address - Country:US
Practice Address - Phone:773-884-3300
Practice Address - Fax:773-284-1223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCA3244OtherRAILROAD MEDICARE
IL01618378OtherBCBS PROVIDER ID
ILCB1028OtherRAILROAD MEDICARE
ILCA3244OtherRAILROAD MEDICARE
IL01618378OtherBCBS PROVIDER ID
ILCA3244OtherRAILROAD MEDICARE
IL908800Medicare PIN