Provider Demographics
NPI:1649228354
Name:CHICAGO HEART AND VASCULAR CONSULTANTS, LTD
Entity Type:Organization
Organization Name:CHICAGO HEART AND VASCULAR CONSULTANTS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM-TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-567-2380
Mailing Address - Street 1:2525 S MICHIGAN AVE
Mailing Address - Street 2:12TH FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2333
Mailing Address - Country:US
Mailing Address - Phone:312-567-2380
Mailing Address - Fax:312-328-7739
Practice Address - Street 1:2525 S MICHIGAN AVE
Practice Address - Street 2:12TH FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2333
Practice Address - Country:US
Practice Address - Phone:312-567-2380
Practice Address - Fax:312-328-7739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILN301570OtherWELLCARE PROVIDER
IN200870020 AOtherINDIANA MEDICAID
IL21620248OtherBLUE CROSS/BLUE SHIELD ID
IL475460Medicare PIN
IN200870020 AOtherINDIANA MEDICAID