Healthcare Provider Details

I. General information

NPI: 1568484665
Provider Name (Legal Business Name): CARDIOLOGY-INTERNAL MEDICINE CONSULTANTS, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16532 S OAK PARK AVE SUITE 200
TINLEY PARK IL
60477-2273
US

IV. Provider business mailing address

16532 S OAK PARK AVE SUITE 200
TINLEY PARK IL
60477-2273
US

V. Phone/Fax

Practice location:
  • Phone: 708-532-1104
  • Fax: 708-532-5539
Mailing address:
  • Phone: 708-532-1104
  • Fax: 708-532-5539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036088831
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036046105
License Number StateIL

VIII. Authorized Official

Name: DR. RUBEN CHUQUIMIA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 708-532-1104