Provider Demographics
NPI: | 1568420438 |
---|---|
Name: | CLINICAL CARDIOLOGY CONSULTANTS, S.C. |
Entity Type: | Organization |
Organization Name: | CLINICAL CARDIOLOGY CONSULTANTS, S.C. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JOHN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BAJGROWICZ |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 708-450-4935 |
Mailing Address - Street 1: | 675 W NORTH AVE |
Mailing Address - Street 2: | SUITE 216 |
Mailing Address - City: | MELROSE PARK |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60160-1634 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 708-450-4935 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 675 W NORTH AVE STE 101 |
Practice Address - Street 2: | |
Practice Address - City: | MELROSE PARK |
Practice Address - State: | IL |
Practice Address - Zip Code: | 60160-1666 |
Practice Address - Country: | US |
Practice Address - Phone: | 708-450-4935 |
Practice Address - Fax: | 708-345-1618 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-05-02 |
Last Update Date: | 2024-04-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Single Specialty |