Provider Demographics
NPI:1710037320
Name:SUBURBAN CARDIOLOGISTS, S.C.
Entity Type:Organization
Organization Name:SUBURBAN CARDIOLOGISTS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-325-9010
Mailing Address - Street 1:333 CHESTNUT ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3247
Mailing Address - Country:US
Mailing Address - Phone:630-325-9010
Mailing Address - Fax:630-325-9023
Practice Address - Street 1:420 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 210
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-4925
Practice Address - Country:US
Practice Address - Phone:630-325-9010
Practice Address - Fax:630-325-9023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL742620Medicare ID - Type Unspecified