MEDICARE: NORTH-WEST CARDIO-VASCULAR CENTER

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	0362097687	IL

General Provider Information

NPI Number	:	1902079718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH-WEST CARDIO-VASCULAR CENTER

Provider Business Mailing Address
First Line	:	3115 N HARLEM AVE
Second Line	:	SUITE 202
City	:	CHICAGO
State	:	IL
Zip	:	60634-4684
Country	:	US
Telephone Number	:	773-622-5200
Fax Number	:	773-889-6571

Provider Business Practice Location Address
First Line	:	3115 N HARLEM AVE
Second Line	:	SUITE 202
City	:	CHICAGO
State	:	IL
Zip	:	60634-4684
Country	:	US
Telephone Number	:	773-622-5200
Fax Number	:	773-889-6571

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MIROSLAW T SOCHANSKI
Credential	:	M.D.
Telephone Number	:	773-622-5200

Provider Enumeration Date	:	04/12/2008
Last Update Date	:	11/29/2010

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