Basic Information
| Provider Information | |||||||||
| NPI: | 1568484665 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARDIOLOGY-INTERNAL MEDICINE CONSULTANTS, S.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16532 S OAK PARK AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | TINLEY PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604772273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7085321104 | ||||||||
| FaxNumber: | 7085325539 | ||||||||
| Practice Location | |||||||||
| Address1: | 16532 S OAK PARK AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | TINLEY PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604772273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7085321104 | ||||||||
| FaxNumber: | 7085325539 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 11/17/2008 | ||||||||
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| AuthorizedOfficialLastName: | CHUQUIMIA | ||||||||
| AuthorizedOfficialFirstName: | RUBEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7085321104 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 036046105 | IL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207R00000X | 036088831 | IL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | CK6656 | 01 | IL | RAILROAD MEDICARE | OTHER | 01633130 | 01 | IL | BLUE SHIELD OF ILLINOIS | OTHER |