Provider Demographics
NPI:1265407399
Name:CARDIAC CONSULTANTS SC
Entity type:Organization
Organization Name:CARDIAC CONSULTANTS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SUBHASH
Authorized Official - Middle Name:J
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACP FACC
Authorized Official - Phone:309-672-3140
Mailing Address - Street 1:900 MAIN STREET
Mailing Address - Street 2:SUITE 320
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61602
Mailing Address - Country:US
Mailing Address - Phone:309-672-3140
Mailing Address - Fax:309-672-3145
Practice Address - Street 1:900 MAIN STREET
Practice Address - Street 2:SUITE 320
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61602
Practice Address - Country:US
Practice Address - Phone:309-672-3140
Practice Address - Fax:309-672-3145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036072639207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036072639Medicaid
E39223Medicare UPIN
IL036072639Medicaid