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General NPI Number Information
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NPI Number | 1265001010
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Entity Type | Organization
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Legal Business Name | PRIME CARDIAC ASSOCIATION P C
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Dates
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Enumeration Date | 06/24/2021
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Last Update Date | 06/24/2021
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Provider Practice Location Address
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Address Line | 12800 S RIDGELAND AVE STE D
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-2391
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Country | US
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Telephone | 708-389-7663
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Fax | 708-389-7664
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Provider Business Mailing Address
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Address Line | 10842 FRANK LN
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City | ORLAND PARK
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State | IL
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Zip | 60467-4594
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Country | US
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Telephone | 219-659-7000
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHITTARANJAN A PATEL
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Credential | MD
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Telephone | 219-659-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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