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NPI Code Detail

MEDICARE: CARDIACFIT LLC

MEDICARE: CARDIACFIT LLC
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
1363LF0000XFamily Nurse Practitioner

General Provider Information

NPI Number : 1710575279
Entity Type Code : Organization
Provider Name (Legal Business Name) : CARDIACFIT LLC
Provider Business Mailing Address
First Line : 2504 N RICHMOND ST UNIT 1
Second Line :
City : CHICAGO
State : IL
Zip : 60647-2620
Country : US
Telephone Number : 360-798-8738
Fax Number :
Provider Business Practice Location Address
First Line : 2504 N RICHMOND ST UNIT 1
Second Line :
City : CHICAGO
State : IL
Zip : 60647-2620
Country : US
Telephone Number : 360-798-8738
Fax Number :
Authorized Official
Title or Position : CEO
Name : EDWARD BRIAN BENDORAITIS
Credential : EXERCISE PHYS
Telephone Number : 773-230-1969
Provider Enumeration Date : 01/08/2021
Last Update Date : 01/08/2021

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Directions to “CARDIACFIT LLC ” Practice Location

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