Healthcare Provider Details

I. General information

NPI: 1336488212
Provider Name (Legal Business Name): THE CARDIOLOGY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2013
Last Update Date: 02/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 W 95TH ST SUITE 305
EVERGREEN PARK IL
60805-2735
US

IV. Provider business mailing address

2850 W 95TH ST SUITE 305
EVERGREEN PARK IL
60805-2735
US

V. Phone/Fax

Practice location:
  • Phone: 708-425-7272
  • Fax:
Mailing address:
  • Phone: 708-425-7272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number209.005662
License Number StateIL

VIII. Authorized Official

Name: DR. DANIEL ROWAN
Title or Position: PARTNER
Credential:
Phone: 708-425-7272