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General NPI Number Information
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NPI Number | 1457584450
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Entity Type | Organization
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Legal Business Name | NORTH LAKE CARDIOVASCULAR CENTER PC
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Dates
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Enumeration Date | 08/25/2009
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Last Update Date | 02/02/2026
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Provider Practice Location Address
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Address Line | 310 S GREENLEAF ST SUITE 212
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City | GURNEE
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State | IL
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Zip | 60031-5708
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Country | US
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Telephone | 847-360-1000
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Fax | 847-360-1001
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Provider Business Mailing Address
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Address Line | 310 S GREENLEAF ST SUITE 212
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City | GURNEE
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State | IL
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Zip | 60031-5708
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Country | US
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Telephone | 847-360-1000
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Fax | 847-360-1001
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Authorized Official
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Title or Position | CEO
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Name | DR. AHMED S HASHIM
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Credential | M.D.
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Telephone | 847-360-1000
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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 | 036101448
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License Number State | IL
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