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General NPI Number Information
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NPI Number | 1093074155
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE CARDIOVASCULAR CARE, LLC
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Dates
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Enumeration Date | 05/10/2012
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Last Update Date | 11/09/2012
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Provider Practice Location Address
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Address Line | 1790 NATIONS DR STE 111
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City | GURNEE
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State | IL
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Zip | 60031-9175
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Country | US
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Telephone | 224-656-5867
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Fax | 219-926-3524
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Provider Business Mailing Address
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Address Line | PO BOX 2257
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City | CHESTERTON
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State | IN
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Zip | 46304-0357
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Country | US
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Telephone | 219-926-8320
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Fax | 219-926-3524
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | TRACY FREEZE
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Credential |
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Telephone | 219-926-8320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 036101942
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License Number State | IL
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