Healthcare Provider Details

I. General information

NPI: 1306031331
Provider Name (Legal Business Name): HEART CARE USA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10537 S EWING AVE LOWER LEVEL
CHICAGO IL
60617-6220
US

IV. Provider business mailing address

10537 S EWING AVE LOWER LEVEL
CHICAGO IL
60617-6220
US

V. Phone/Fax

Practice location:
  • Phone: 312-212-4570
  • Fax: 773-734-0407
Mailing address:
  • Phone: 312-212-4570
  • Fax: 773-734-0407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. TERENCE BERNARD ELLIS
Title or Position: OWNER
Credential:
Phone: 312-212-4570