MEDICARE: WEST SUBURBAN CARDIOLOGISTS, 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	207RC0001X	Clinical Cardiac Electrophysiology Physician	060000983	IL
2	363L00000X	Nurse Practitioner	06000983	IL
3	207RC0000X	Cardiovascular Disease Physician	060000983	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1616378	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1316998578
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST SUBURBAN CARDIOLOGISTS, LTD.

Provider Business Mailing Address
First Line	:	900 S FRONTAGE RD
Second Line	:	SUITE 325
City	:	WOODRIDGE
State	:	IL
Zip	:	60517-4903
Country	:	US
Telephone Number	:	773-880-9722
Fax Number	:	773-880-9723

Provider Business Practice Location Address
First Line	:	3118 N ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3014
Country	:	US
Telephone Number	:	773-880-9722
Fax Number	:	773-880-9723

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. AJAY BADDI
Credential	:	M.D.
Telephone Number	:	773-880-9722

Provider Enumeration Date	:	05/13/2006
Last Update Date	:	12/21/2010

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Directions to “WEST SUBURBAN CARDIOLOGISTS, LTD. ” Practice Location

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