Provider Demographics
NPI:1942499397
Name:CARDIOTHORACIC & VASCULAR SURGEONS & ASSOC SC
Entity Type:Organization
Organization Name:CARDIOTHORACIC & VASCULAR SURGEONS & ASSOC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:NATALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-222-1443
Mailing Address - Street 1:31 LAKE ADALYN DR
Mailing Address - Street 2:
Mailing Address - City:S BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-9541
Mailing Address - Country:US
Mailing Address - Phone:847-222-1443
Mailing Address - Fax:847-222-1445
Practice Address - Street 1:5140 N CALIFORNIA AVE
Practice Address - Street 2:SUITE 780
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3645
Practice Address - Country:US
Practice Address - Phone:773-878-0148
Practice Address - Fax:847-222-1445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01636263OtherBLUE CROSS BLUE SHIELD
ILK47100OtherMEDICARE PTAN
ILK47100OtherMEDICARE PTAN
ILA15376Medicare UPIN