Healthcare Provider Details

I. General information

NPI: 1295906147
Provider Name (Legal Business Name): HEART CARE CENTERS OF SOUTH CHICAGO, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9011 S COMMERCIAL AVE
CHICAGO IL
60617-4304
US

IV. Provider business mailing address

833 W LINCOLN HWY SUITE 200W
SCHERERVILLE IN
46375-1638
US

V. Phone/Fax

Practice location:
  • Phone: 773-933-0700
  • Fax:
Mailing address:
  • Phone: 219-934-5300
  • Fax: 219-934-5389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: VIRENDRA BISLA
Title or Position: PRESIDENT
Credential: MD
Phone: 773-933-0700