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General NPI Number Information
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NPI Number | 1710575279
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Entity Type | Organization
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Legal Business Name | CARDIACFIT LLC
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Dates
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Enumeration Date | 01/08/2021
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Last Update Date | 01/08/2021
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Provider Practice Location Address
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Address Line | 2504 N RICHMOND ST UNIT 1
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City | CHICAGO
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State | IL
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Zip | 60647-2620
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Country | US
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Telephone | 360-798-8738
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Fax |
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Provider Business Mailing Address
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Address Line | 2504 N RICHMOND ST UNIT 1
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City | CHICAGO
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State | IL
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Zip | 60647-2620
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Country | US
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Telephone | 360-798-8738
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | EDWARD BRIAN BENDORAITIS
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Credential | EXERCISE PHYS
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Telephone | 773-230-1969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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