Basic Information
| Provider Information | |||||||||
| NPI: | 1316059942 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARDIOSPECIALISTS GROUP LTD | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MIDWEST ARRHYTHMIA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 97680 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606787680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087489800 | ||||||||
| FaxNumber: | 7087489807 | ||||||||
| Practice Location | |||||||||
| Address1: | 375 N WALL ST | ||||||||
| Address2: | SUITE 420 | ||||||||
| City: | KANKAKEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 609013483 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159399400 | ||||||||
| FaxNumber: | 8159399494 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 10/22/2007 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HASPEL | ||||||||
| AuthorizedOfficialFirstName: | LAWRENCE | ||||||||
| AuthorizedOfficialMiddleName: | U | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER / PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7087489800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | 21608902 | 01 | IL | BC BS OF IL | OTHER |