Provider Demographics
NPI:1750439493
Name:LINCOLN PARK CARDIOVASCULAR AND THORACIC SURGEONS, SC
Entity type:Organization
Organization Name:LINCOLN PARK CARDIOVASCULAR AND THORACIC SURGEONS, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:BREYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-477-4343
Mailing Address - Street 1:1095 PAYSPHERE CIR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-6156
Mailing Address - Country:US
Mailing Address - Phone:773-477-4343
Mailing Address - Fax:773-477-5088
Practice Address - Street 1:2800 N SHERIDAN RD
Practice Address - Street 2:SUITE 209
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6156
Practice Address - Country:US
Practice Address - Phone:773-477-4343
Practice Address - Fax:773-477-5088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL060007657OtherRAILROAD MEDICARE
ILCA6737OtherRAILROAD MEDICARE
IL036047470Medicaid
IL060028585OtherRAILROAD MEDICARE
IL968650OtherMEDICARE PROVIDER
IL036078287Medicaid
IL31603025OtherBLUECROSS BLUESHIELD
ILL19443Medicare PIN
ILCA6737OtherRAILROAD MEDICARE
ILL19444Medicare PIN
ILF19158Medicare UPIN