MEDICARE: MIDWEST CARDIAC CENTER SC

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	207RC0000X	Cardiovascular Disease Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CA3244	OTHER	IL	RAILROAD MEDICARE
3	CB1028	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	01618378	OTHER	IL	BCBS PROVIDER ID

General Provider Information

NPI Number	:	1518978923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST CARDIAC CENTER SC

Provider Business Mailing Address
First Line	:	PO BOX 3461
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60522-3461
Country	:	US
Telephone Number	:	773-884-3300
Fax Number	:

Provider Business Practice Location Address
First Line	:	6441 S PULASKI RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-5148
Country	:	US
Telephone Number	:	773-884-3300
Fax Number	:	773-284-1223

Authorized Official
Title or Position	:	DELEGATED OFFIICAL
Name	:	GOPAL LALMALANI
Credential	:	MD
Telephone Number	:	630-792-0900

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	05/28/2020

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Directions to “MIDWEST CARDIAC CENTER SC ” Practice Location

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