Basic Information
| Provider Information | |||||||||
| NPI: | 1417908765 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIDWEST HEART SPECIALISTS, LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1919 S HIGHLAND AVE | ||||||||
| Address2: | SUITE B202 | ||||||||
| City: | LOMBARD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601486153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302681102 | ||||||||
| FaxNumber: | 6302681125 | ||||||||
| Practice Location | |||||||||
| Address1: | 3825 HIGHLAND AVE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | DOWNERS GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605151552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307194999 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 08/02/2007 | ||||||||
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| AuthorizedOfficialLastName: | MAREK | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6307194799 | ||||||||
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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 | 207R00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0001X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | 207RI0011X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 2085R0204X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 207RC0000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 02215038 | 01 | IL | BCBS | OTHER |