Provider Demographics
NPI:1750673828
Name:CARDIOTHORACIC ENDOSCOPIC SURGICAL
Entity Type:Organization
Organization Name:CARDIOTHORACIC ENDOSCOPIC SURGICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:PANARES
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:312-593-0824
Mailing Address - Street 1:4717 W. PENSACOLA AVE.
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-1683
Mailing Address - Country:US
Mailing Address - Phone:312-593-0824
Mailing Address - Fax:
Practice Address - Street 1:800 BIESTERFIELD ROAD
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3397
Practice Address - Country:US
Practice Address - Phone:847-437-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238.000082363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty