Healthcare Provider Details

I. General information

NPI: 1679685705
Provider Name (Legal Business Name): CARDIOSPECIALISTS GROUP LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 MACARTHUR BLVD SUITE 203
MUNSTER IN
46321
US

IV. Provider business mailing address

PO BOX 97680
CHICAGO IL
60678-7680
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-9390
  • Fax: 219-836-9392
Mailing address:
  • Phone: 708-748-9800
  • Fax: 708-748-9807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. LAWRENCE U HASPEL
Title or Position: PRESIDENT AND MANAGING PARTNER
Credential: DO
Phone: 708-748-9800