MEDICARE: CARDIAC EP CONSULTANTS 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	207RC0001X	Clinical Cardiac Electrophysiology Physician		IL

General Provider Information

NPI Number	:	1730139924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIAC EP CONSULTANTS SC

Provider Business Mailing Address
First Line	:	PO BOX 175
Second Line	:
City	:	LINCOLNSHIRE
State	:	IL
Zip	:	60069-0175
Country	:	US
Telephone Number	:	847-367-7171
Fax Number	:	847-367-7177

Provider Business Practice Location Address
First Line	:	900 TECHNOLOGY WAY
Second Line	:	SUITE 220
City	:	LIBERTYVILLE
State	:	IL
Zip	:	60048-5364
Country	:	US
Telephone Number	:	847-367-7171
Fax Number	:	847-367-7177

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MEHRAN JABBARZADEH
Credential	:	MD
Telephone Number	:	847-367-7171

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	07/21/2022

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