Basic Information
| Provider Information | |||||||||
| NPI: | 1417046731 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DUPAGE CARDIOLOGY SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 777 OAKMONT LN | ||||||||
| Address2: | SUITE 1600 | ||||||||
| City: | WESTMONT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605595511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307892550 | ||||||||
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| Practice Location | |||||||||
| Address1: | 303 E ARMY TRAIL RD | ||||||||
| Address2: | SUITE 405 | ||||||||
| City: | BLOOMINGDALE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601082169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6303070100 | ||||||||
| FaxNumber: | 6303070111 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 09/29/2011 | ||||||||
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| AuthorizedOfficialLastName: | KUMAR | ||||||||
| AuthorizedOfficialFirstName: | VIJAY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6303070100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | DF8341 | 01 | IL | RAILROAD MEDICARE | OTHER | 2233084 | 01 | IL | BCBS PROVIDER ID | OTHER |