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General NPI Number Information
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NPI Number | 1114177508
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Entity Type | Organization
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Legal Business Name | KISHWAUKEE CARDIOLOGY ASSOCIATES, LTD
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Dates
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Enumeration Date | 09/23/2008
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Last Update Date | 03/21/2016
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Provider Practice Location Address
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Address Line | 2550 HAUSER ROSS DR STE 100
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City | SYCAMORE
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State | IL
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Zip | 60178-3149
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Country | US
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Telephone | 815-786-7076
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Fax | 815-786-7379
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Provider Business Mailing Address
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Address Line | 2530 HAUSER ROSS DR STE 100
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City | SYCAMORE
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State | IL
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Zip | 60178-3162
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Country | US
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Telephone | 815-748-7076
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Fax | 815-748-7070
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAGDISH R PATEL
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Credential | M.D., FACC
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Telephone | 815-786-7076
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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 |
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License Number State | IL
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