Healthcare Provider Details

I. General information

NPI: 1669928966
Provider Name (Legal Business Name): CARDINAL MEDICAL SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 08/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 S LA SALLE ST SUITE 214
CHICAGO IL
60604-1000
US

IV. Provider business mailing address

208 LASALLE STREET SUITE 214
CHICAGO IL
60604
US

V. Phone/Fax

Practice location:
  • Phone: 855-200-8262
  • Fax:
Mailing address:
  • Phone: 855-200-8262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number036-099445
License Number StateIL

VIII. Authorized Official

Name: AMJAD SAFVI
Title or Position: MEDICAL DOCTOR
Credential: M.D
Phone: 630-650-0580