Healthcare Provider Details

I. General information

NPI: 1932259611
Provider Name (Legal Business Name): CARDIAC CONSULTING GROUP SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 W 156TH ST SUITE 305
HARVEY IL
60426-4260
US

IV. Provider business mailing address

71 W 156TH ST SUITE 305
HARVEY IL
60426-4260
US

V. Phone/Fax

Practice location:
  • Phone: 708-331-2200
  • Fax: 708-331-8015
Mailing address:
  • Phone: 708-331-2200
  • Fax: 708-331-8015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: ANGEL CASTANER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 708-331-2200