Healthcare Provider Details

I. General information

NPI: 1275990707
Provider Name (Legal Business Name): CARDIAC VISION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2016
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

948 N DAMEN AVE
CHICAGO IL
60622-4910
US

IV. Provider business mailing address

948 N DAMEN AVE
CHICAGO IL
60622-4910
US

V. Phone/Fax

Practice location:
  • Phone: 904-296-7775
  • Fax: 904-330-1027
Mailing address:
  • Phone: 904-296-7775
  • Fax: 904-330-1027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JUNAID AHMED
Title or Position: OWNER
Credential: M.D
Phone: 904-296-7775