Provider Demographics
NPI:1992829634
Name:TALLGRASS CARDIOLOGY SC
Entity Type:Organization
Organization Name:TALLGRASS CARDIOLOGY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HERSHEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:WIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-937-9370
Mailing Address - Street 1:500 N WALL ST STE 100
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-2942
Mailing Address - Country:US
Mailing Address - Phone:815-937-9370
Mailing Address - Fax:815-937-9890
Practice Address - Street 1:500 N WALL ST STE 100
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-2942
Practice Address - Country:US
Practice Address - Phone:815-937-9370
Practice Address - Fax:815-937-9890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty