Basic Information
| Provider Information | |||||||||
| NPI: | 1508026030 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOUNT SINAI MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | CALIFORNIA AT 15 TH STREET | ||||||||
| Address2: | DEPARTMENT OF CARDIOLOGY | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60608 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | CALIFORNIA AT 15 TH STREET | ||||||||
| Address2: | DEPARTMENT OF CARDIOLOGY | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732576452 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2008 | ||||||||
| LastUpdateDate: | 06/09/2008 | ||||||||
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| AuthorizedOfficialLastName: | JAWAD | ||||||||
| AuthorizedOfficialFirstName: | EVYAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CARDIOLOGY FELLOW | ||||||||
| AuthorizedOfficialTelephone: | 7732576452 | ||||||||
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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 | 282N00000X | 036099316 | IL | Y | Hospitals | General Acute Care Hospital |
No ID Information.