Provider Demographics
NPI:1730139924
Name:CARDIAC EP CONSULTANTS SC
Entity Type:Organization
Organization Name:CARDIAC EP CONSULTANTS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEHRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JABBARZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-367-7171
Mailing Address - Street 1:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:LINCOLNSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60069-0175
Mailing Address - Country:US
Mailing Address - Phone:847-367-7171
Mailing Address - Fax:847-367-7177
Practice Address - Street 1:900 TECHNOLOGY WAY
Practice Address - Street 2:SUITE 220
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5364
Practice Address - Country:US
Practice Address - Phone:847-367-7171
Practice Address - Fax:847-367-7177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213594Medicare ID - Type UnspecifiedGROUP NUMBER