Healthcare Provider Details

I. General information

NPI: 1528017100
Provider Name (Legal Business Name): CARDIOLOGY ASSOCIATES OF NORTHERN ILLINOIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 09/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MADISON ST STE 207
JOLIET IL
60435-6549
US

IV. Provider business mailing address

301 MADISON ST SUITE 275
JOLIET IL
60435-6549
US

V. Phone/Fax

Practice location:
  • Phone: 815-740-1900
  • Fax: 815-725-2413
Mailing address:
  • Phone: 815-740-1900
  • Fax: 815-725-2413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ABDUL H SANKARI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 815-740-1900