Provider Demographics
NPI:1831261825
Name:ADVANCED CARDIAC CARE PC
Entity type:Organization
Organization Name:ADVANCED CARDIAC CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACQUES
Authorized Official - Middle Name:
Authorized Official - Last Name:FOURCAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-897-5995
Mailing Address - Street 1:326 W 64TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621-3114
Mailing Address - Country:US
Mailing Address - Phone:847-897-5995
Mailing Address - Fax:847-897-5990
Practice Address - Street 1:326 W 64TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-3114
Practice Address - Country:US
Practice Address - Phone:847-897-5995
Practice Address - Fax:847-897-5990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208327Medicare ID - Type UnspecifiedGROUP MEDICARE #
ILC43895Medicare UPIN