Healthcare Provider Details

I. General information

NPI: 1861007239
Provider Name (Legal Business Name): MARIAN HEART RHYTHM CONSULTANTS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2020
Last Update Date: 09/13/2020
Certification Date: 09/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 W DIVISION ST STE 205
CHICAGO IL
60622-3094
US

IV. Provider business mailing address

1S376 SUMMIT AVE STE 4C
OAKBROOK TERRACE IL
60181-3966
US

V. Phone/Fax

Practice location:
  • Phone: 312-593-1343
  • Fax: 630-396-2677
Mailing address:
  • Phone: 630-424-1122
  • Fax: 630-396-2677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN DUQUE
Title or Position: CEO
Credential: MD
Phone: 312-593-1343