MEDICARE: CARDIOVASCULAR SERVICE ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician		IL
2	207RC0000X	Cardiovascular Disease Physician		IL

General Provider Information

NPI Number	:	1396799862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOVASCULAR SERVICE ASSOCIATES

Provider Business Mailing Address
First Line	:	PO BOX 388309
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-8309
Country	:	US
Telephone Number	:	773-585-7505
Fax Number	:	773-585-7507

Provider Business Practice Location Address
First Line	:	7425 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-2139
Country	:	US
Telephone Number	:	773-585-7505
Fax Number	:	773-585-7507

Authorized Official
Title or Position	:	OWNER
Name	:	BOHDAN FEDIRKO
Credential	:	MD
Telephone Number	:	773-585-7505

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	01/28/2019

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