Healthcare Provider Details

I. General information

NPI: 1215984745
Provider Name (Legal Business Name): CHICAGO CARDIO DIAGNOSTICS, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2006
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 WILLOBY CT
SCHAUMBURG IL
60173-2161
US

IV. Provider business mailing address

PO BOX 59111
SCHAUMBURG IL
60159-0111
US

V. Phone/Fax

Practice location:
  • Phone: 847-995-8001
  • Fax: 847-413-0922
Mailing address:
  • Phone: 847-995-8001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number5532-4134
License Number StateIL

VIII. Authorized Official

Name: MR. MATTHEW L DESROSIERS
Title or Position: MEMBER
Credential:
Phone: 847-995-8001