Healthcare Provider Details

I. General information

NPI: 1720158264
Provider Name (Legal Business Name): CARDIO DIAGNOSTIC SYSTEMS, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10035 LINCOLN TRL
FAIRVIEW HEIGHTS IL
62208-1847
US

IV. Provider business mailing address

10035 LINCOLN TRL
FAIRVIEW HEIGHTS IL
62208-1847
US

V. Phone/Fax

Practice location:
  • Phone: 618-397-7300
  • Fax: 618-397-7735
Mailing address:
  • Phone: 618-397-7300
  • Fax: 618-397-7735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246X00000X
TaxonomyCardiovascular Specialist/Technologist
License Number
License Number StateIL

VIII. Authorized Official

Name: PANKAJ S SHAH
Title or Position: PRESIDENT
Credential: MD
Phone: 618-397-7300