Provider Demographics
NPI:1720179831
Name:ASSOCIATED CARDIOVASCULAR PHYSICIANS, S.C
Entity Type:Organization
Organization Name:ASSOCIATED CARDIOVASCULAR PHYSICIANS, S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:PORONSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-923-7650
Mailing Address - Street 1:12400 S HARLEM AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1477
Mailing Address - Country:US
Mailing Address - Phone:708-923-7650
Mailing Address - Fax:708-923-7655
Practice Address - Street 1:12400 S HARLEM AVE STE 112
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1477
Practice Address - Country:US
Practice Address - Phone:708-923-7650
Practice Address - Fax:708-923-7655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1617658OtherBC/BS
IL760800Medicare ID - Type Unspecified