MEDICARE: CARDIAC DIAGNOSIS, LTD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	036048047	IL

General Provider Information

NPI Number	:	1164449823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIAC DIAGNOSIS, LTD.

Provider Business Mailing Address
First Line	:	4901 W 79TH ST
Second Line	:	SUITE 7
City	:	BURBANK
State	:	IL
Zip	:	60459-1554
Country	:	US
Telephone Number	:	708-424-2024
Fax Number	:	708-424-2084

Provider Business Practice Location Address
First Line	:	4901 W 79TH ST
Second Line	:	SUITE 7
City	:	BURBANK
State	:	IL
Zip	:	60459-1554
Country	:	US
Telephone Number	:	708-424-2024
Fax Number	:	708-424-2084

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. SIVARAMAPRASAD TUMMALA
Credential	:	M.D.
Telephone Number	:	708-424-2024

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	07/15/2010

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