Basic Information
| Provider Information | |||||||||
| NPI: | 1619908969 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FOX VALLEY CARDIOVASCULAR CONSULTANTS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2088 OGDEN AVE | ||||||||
| Address2: | SUITE 160 | ||||||||
| City: | AURORA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308516440 | ||||||||
| FaxNumber: | 6308592422 | ||||||||
| Practice Location | |||||||||
| Address1: | 2088 OGDEN AVE | ||||||||
| Address2: | SUITE 160 | ||||||||
| City: | AURORA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308516440 | ||||||||
| FaxNumber: | 6308592422 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 12/19/2007 | ||||||||
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| AuthorizedOfficialLastName: | GILL | ||||||||
| AuthorizedOfficialFirstName: | SANTOSH | ||||||||
| AuthorizedOfficialMiddleName: | KAUR | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 6308516440 | ||||||||
| IsSoleProprietor: | |||||||||
| 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 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | CI5836 | 01 | IL | RAILROAD MEDICARE | OTHER |