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General NPI Number Information
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NPI Number | 1952467375
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Entity Type | Organization
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Legal Business Name | INTRA-HEARTS SERVICE CORPORATION
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 14475 JOHN HUMPHREY DR STE 100
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City | ORLAND PARK
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State | IL
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Zip | 60462-6216
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Country | US
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Telephone | 708-206-0305
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Fax | 708-206-0300
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Provider Business Mailing Address
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Address Line | PO BOX 947
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City | ORLAND PARK
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State | IL
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Zip | 60462-0947
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Country | US
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Telephone | 708-206-0305
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Fax | 708-206-0300
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Authorized Official
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Title or Position | PRESIDENT
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Name | SAMUEL P MATHEW
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Credential | MD
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Telephone | 708-206-0305
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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 | 036065418
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License Number State | IL
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