Healthcare Provider Details

I. General information

NPI: 1093931032
Provider Name (Legal Business Name): CARDIOVASCULAR ASSOCIATES OF GLENBROOK AND EVANSTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1713 CENTRAL ST
EVANSTON IL
60201-1507
US

IV. Provider business mailing address

1713 CENTRAL ST
EVANSTON IL
60201-1507
US

V. Phone/Fax

Practice location:
  • Phone: 847-869-1499
  • Fax: 847-869-2932
Mailing address:
  • Phone: 847-869-1499
  • Fax: 847-869-2932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number202886
License Number StateIL

VIII. Authorized Official

Name: DR. IRWIN M SILVERMAN
Title or Position: PARTNER
Credential: MD
Phone: 847-869-1499