Provider Demographics
NPI:1568859866
Name:CARDIO MEDICAL CENTER SC
Entity Type:Organization
Organization Name:CARDIO MEDICAL CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RIAZ
Authorized Official - Middle Name:A
Authorized Official - Last Name:AKHTAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACC
Authorized Official - Phone:630-710-6020
Mailing Address - Street 1:4505 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2621
Mailing Address - Country:US
Mailing Address - Phone:708-229-0081
Mailing Address - Fax:630-206-1634
Practice Address - Street 1:4505 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2621
Practice Address - Country:US
Practice Address - Phone:708-229-0081
Practice Address - Fax:630-206-1634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-24
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036047761207RC0000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty