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General NPI Number Information
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NPI Number | 1083809776
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Entity Type | Organization
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Legal Business Name | CONSULTANT IN CARDIOVASCULAR IMAGING,S.C.
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Dates
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Enumeration Date | 09/06/2007
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Last Update Date | 05/10/2012
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Provider Practice Location Address
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Address Line | 675 W NORTH AVE STE-208
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City | MELROSE PARK
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State | IL
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Zip | 60160-1634
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Country | US
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Telephone | 708-343-4302
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Fax | 708-343-4341
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Provider Business Mailing Address
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Address Line | 675 W NORTH AVE STE-208
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City | MELROSE PARK
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State | IL
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Zip | 60160-1634
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Country | US
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Telephone | 708-343-4302
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Fax | 708-343-4341
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Authorized Official
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Title or Position | ADMINISTRATIVE MANAGER
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Name | MS. JEN GRIMES
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Credential |
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Telephone | 708-343-4302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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