Healthcare Provider Details

I. General information

NPI: 1740231505
Provider Name (Legal Business Name): CARDIOVASCULAR ASSOCIATES, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 02/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 BIESTERFIELD RD STE G01 WIMMER BUILDING
ELK GROVE VILLAGE IL
60007-3372
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 847-981-3680
  • Fax: 847-956-5122
Mailing address:
  • Phone: 847-981-3680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number42007401
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number42007401
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number42007401
License Number StateIL

VIII. Authorized Official

Name: JACK R CHAMBERLIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 847-981-3680