Provider Demographics
NPI:1134445117
Name:UNIVERSITY MEDICINE AND CARDIOLOGY
Entity type:Organization
Organization Name:UNIVERSITY MEDICINE AND CARDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STAMATIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMITROPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-630-4129
Mailing Address - Street 1:PO BOX 8154
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-8154
Mailing Address - Country:US
Mailing Address - Phone:847-630-4129
Mailing Address - Fax:630-214-5778
Practice Address - Street 1:8110 S CASS AVE
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-5013
Practice Address - Country:US
Practice Address - Phone:630-963-4000
Practice Address - Fax:630-214-5778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036114665207R00000X, 207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty