Healthcare Provider Details

I. General information

NPI: 1740428184
Provider Name (Legal Business Name): ELITE CARDIOLOGY SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2009
Last Update Date: 11/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 HAUSER ROSS DRIVE SUITE 325
SYCAMORE IL
60178-3180
US

IV. Provider business mailing address

2550 HAUSER ROSS DRIVE SUITE 325
SYCAMORE IL
60178-3180
US

V. Phone/Fax

Practice location:
  • Phone: 815-758-7700
  • Fax: 815-748-3070
Mailing address:
  • Phone: 815-758-7700
  • Fax: 815-748-3070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number036116210
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL H NGUYEN
Title or Position: PHYSICIAN/MANAGER
Credential: M.D.
Phone: 815-758-7700