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General NPI Number Information
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NPI Number | 1861007239
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Entity Type | Organization
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Legal Business Name | MARIAN HEART RHYTHM CONSULTANTS SC
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Dates
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Enumeration Date | 09/13/2020
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Last Update Date | 09/13/2020
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Provider Practice Location Address
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Address Line | 2222 W DIVISION ST STE 205
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City | CHICAGO
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State | IL
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Zip | 60622-3094
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Country | US
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Telephone | 312-593-1343
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Fax | 630-396-2677
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Provider Business Mailing Address
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Address Line | 1S376 SUMMIT AVE STE 4C
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City | OAKBROOK TERRACE
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State | IL
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Zip | 60181-3966
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Country | US
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Telephone | 630-424-1122
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Fax | 630-396-2677
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Authorized Official
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Title or Position | CEO
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Name | KRISTIN DUQUE
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Credential | MD
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Telephone | 312-593-1343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number |
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License Number State |
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