Healthcare Provider Details

I. General information

NPI: 1316059942
Provider Name (Legal Business Name): CARDIOSPECIALISTS GROUP LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 N WALL ST SUITE 420
KANKAKEE IL
60901-3483
US

IV. Provider business mailing address

PO BOX 97680
CHICAGO IL
60678-7680
US

V. Phone/Fax

Practice location:
  • Phone: 815-939-9400
  • Fax: 815-939-9494
Mailing address:
  • Phone: 708-748-9800
  • Fax: 708-748-9807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LAWRENCE U HASPEL
Title or Position: MANAGING PARTNER / PRESIDENT
Credential: DO
Phone: 708-748-9800