Provider Demographics
NPI:1740428184
Name:ELITE CARDIOLOGY SOLUTIONS LLC
Entity Type:Organization
Organization Name:ELITE CARDIOLOGY SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:H
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-758-7700
Mailing Address - Street 1:2550 HAUSER ROSS DRIVE
Mailing Address - Street 2:SUITE 325
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3180
Mailing Address - Country:US
Mailing Address - Phone:815-758-7700
Mailing Address - Fax:815-748-3070
Practice Address - Street 1:2550 HAUSER ROSS DRIVE
Practice Address - Street 2:SUITE 325
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3180
Practice Address - Country:US
Practice Address - Phone:815-758-7700
Practice Address - Fax:815-748-3070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-22
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036116210174400000X
207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036116210Medicaid
IL036116210Medicaid