Provider Demographics
NPI:1457584450
Name:NORTH LAKE CARDIOVASCULAR CENTER PC
Entity Type:Organization
Organization Name:NORTH LAKE CARDIOVASCULAR CENTER PC
Other - Org Name:NORTHLAKE CARDIOVASCULAR CENTER P.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:S
Authorized Official - Last Name:HASHIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-360-1000
Mailing Address - Street 1:310 S GREENLEAF ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5708
Mailing Address - Country:US
Mailing Address - Phone:847-360-1000
Mailing Address - Fax:847-360-1001
Practice Address - Street 1:310 S GREENLEAF ST
Practice Address - Street 2:SUITE 212
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5708
Practice Address - Country:US
Practice Address - Phone:847-360-1000
Practice Address - Fax:847-360-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-25
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101448207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0004933281OtherBCBS
IL036101448Medicaid
IL0004933281OtherBCBS