Healthcare Provider Details

I. General information

NPI: 1568859866
Provider Name (Legal Business Name): CARDIO MEDICAL CENTER SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2015
Last Update Date: 07/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4505 W 95TH ST
OAK LAWN IL
60453-2621
US

IV. Provider business mailing address

4505 W 95TH ST
OAK LAWN IL
60453-2621
US

V. Phone/Fax

Practice location:
  • Phone: 708-229-0081
  • Fax: 630-206-1634
Mailing address:
  • Phone: 708-229-0081
  • Fax: 630-206-1634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number036047761
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036047761
License Number StateIL

VIII. Authorized Official

Name: DR. RIAZ A AKHTAR
Title or Position: OWNER/DIRECTOR
Credential: MD FACC
Phone: 630-710-6020