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General NPI Number Information
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NPI Number | 1477575504
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Entity Type | Organization
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Legal Business Name | VALLEY MEDICAL & CARDIAC CLINIC, LTD.
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 08/17/2010
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Provider Practice Location Address
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Address Line | 87 N. AIRLITE STTREET SUITE 100
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City | ELGIN
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State | IL
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Zip | 60123-5879
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Country | US
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Telephone | 847-888-2557
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Fax | 847-888-2591
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Provider Business Mailing Address
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Address Line | 87 N AIRLITE ST SUITE 100
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City | ELGIN
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State | IL
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Zip | 60123-4988
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Country | US
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Telephone | 847-888-2557
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Fax | 847-888-2591
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD PARK
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Credential | M.D.
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Telephone | 847-888-2557
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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 | 174400000X
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License Number State | IL
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