Healthcare Provider Details

I. General information

NPI: 1316998578
Provider Name (Legal Business Name): WEST SUBURBAN CARDIOLOGISTS, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 12/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3118 N ASHLAND AVE
CHICAGO IL
60657-3014
US

IV. Provider business mailing address

900 S FRONTAGE RD SUITE 325
WOODRIDGE IL
60517-4903
US

V. Phone/Fax

Practice location:
  • Phone: 773-880-9722
  • Fax: 773-880-9723
Mailing address:
  • Phone: 773-880-9722
  • Fax: 773-880-9723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number060000983
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number06000983
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number060000983
License Number StateIL

VIII. Authorized Official

Name: DR. AJAY BADDI
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 773-880-9722