MEDICARE: LINCOLN PARK HEART CENTER, S.C.

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	207RI0011X	Interventional Cardiology Physician	036048281	IL
2	207RC0000X	Cardiovascular Disease Physician	036048281	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2201358	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1396801536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LINCOLN PARK HEART CENTER, S.C.

Provider Business Mailing Address
First Line	:	62 BAYBROOK LN
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1640
Country	:	US
Telephone Number	:	773-327-8008
Fax Number	:	773-327-0790

Provider Business Practice Location Address
First Line	:	2266 N LINCOLN AVE
Second Line	:	THIRD FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60614-3718
Country	:	US
Telephone Number	:	773-327-8008
Fax Number	:	773-327-0790

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SUKHJIT SINGH GILL
Credential	:	M.D.
Telephone Number	:	773-327-8008

Provider Enumeration Date	:	12/30/2006
Last Update Date	:	07/25/2024

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Directions to “LINCOLN PARK HEART CENTER, S.C. ” Practice Location

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