Healthcare Provider Details

I. General information

NPI: 1861502510
Provider Name (Legal Business Name): CARDIAC DIAGNOSTICS,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 ACADEMY DR
NORTHBROOK IL
60062
US

IV. Provider business mailing address

609 ACADEMY DR
NORTHBROOK IL
60062
US

V. Phone/Fax

Practice location:
  • Phone: 847-537-5555
  • Fax: 847-205-9722
Mailing address:
  • Phone: 847-537-5555
  • Fax: 847-205-9722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246W00000X
TaxonomyCardiology Technician
License Number41206716
License Number StateIL

VIII. Authorized Official

Name: MS. LISA A ANDERSON
Title or Position: RN OWNER
Credential: RN
Phone: 847-537-5555