Healthcare Provider Details

I. General information

NPI: 1356664742
Provider Name (Legal Business Name): AMIRY CARDIOLOGY CONSULTANT MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2010
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102A FOX GLEN CT
BARRINGTON IL
60010-1805
US

IV. Provider business mailing address

102A FOX GLEN CT
BARRINGTON IL
60010-1805
US

V. Phone/Fax

Practice location:
  • Phone: 224-848-4353
  • Fax: 224-848-4356
Mailing address:
  • Phone: 224-848-4353
  • Fax: 224-848-4356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036054225
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number036054225
License Number StateIL

VIII. Authorized Official

Name: DR. ABAS A AMIRY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 224-848-4353