Basic Information
| Provider Information | |||||||||
| NPI: | 1861007239 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARIAN HEART RHYTHM CONSULTANTS SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1S376 SUMMIT AVE STE 4C | ||||||||
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| City: | OAKBROOK TERRACE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601813966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6304241122 | ||||||||
| FaxNumber: | 6303962677 | ||||||||
| Practice Location | |||||||||
| Address1: | 2222 W DIVISION ST STE 205 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606223094 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3125931343 | ||||||||
| FaxNumber: | 6303962677 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2020 | ||||||||
| LastUpdateDate: | 09/13/2020 | ||||||||
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| AuthorizedOfficialLastName: | DUQUE | ||||||||
| AuthorizedOfficialFirstName: | KRISTIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3125931343 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 09/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0001X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
No ID Information.