Basic Information
| Provider Information | |||||||||
| NPI: | 1194844050 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARDIOSPECIALISTS GROUP LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20303 CRAWFORD AVE | ||||||||
| Address2: | SUITE LL3 | ||||||||
| City: | OLYMPIA FIELDS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604611073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087489800 | ||||||||
| FaxNumber: | 7087489807 | ||||||||
| Practice Location | |||||||||
| Address1: | 20303 CRAWFORD AVE | ||||||||
| Address2: | SUITE LL3 | ||||||||
| City: | OLYMPIA FIELDS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604611073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087489800 | ||||||||
| FaxNumber: | 7087489807 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2007 | ||||||||
| LastUpdateDate: | 03/28/2014 | ||||||||
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| AuthorizedOfficialLastName: | SUPRENANT | ||||||||
| AuthorizedOfficialFirstName: | BRAD | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7087489800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0001X | 036071427 | IL | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
No ID Information.