Basic Information
| Provider Information | |||||||||
| NPI: | 1619118049 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH SUBURBAN CARDIOLOGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 820 | ||||||||
| Address2: | |||||||||
| City: | MATTESON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604430820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087990180 | ||||||||
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| Practice Location | |||||||||
| Address1: | 17901 GOVERNORS HWY | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | HOMEWOOD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604301146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087990180 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2009 | ||||||||
| LastUpdateDate: | 03/16/2009 | ||||||||
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| AuthorizedOfficialLastName: | HAMID | ||||||||
| AuthorizedOfficialFirstName: | IMTIAZ | ||||||||
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| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 7087990180 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 036-045222 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.