Basic Information
| Provider Information | |||||||||
| NPI: | 1679685705 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARDIOSPECIALISTS GROUP LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 97680 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606787680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087489800 | ||||||||
| FaxNumber: | 7087489807 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 MACARTHUR BLVD | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | MUNSTER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2198369390 | ||||||||
| FaxNumber: | 2198369392 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 10/17/2007 | ||||||||
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| AuthorizedOfficialLastName: | HASPEL | ||||||||
| AuthorizedOfficialFirstName: | LAWRENCE | ||||||||
| AuthorizedOfficialMiddleName: | U | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT AND MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 7087489800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0001X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | 207RI0011X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | CA4855 | 01 | IN | RR MEDICARE | OTHER |