MEDICARE: PREMIER CARDIOVASCULAR ASSOCIATES INC

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

General Provider Information

NPI Number	:	1992044838
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER CARDIOVASCULAR ASSOCIATES INC

Provider Business Mailing Address
First Line	:	1730 PARK ST
Second Line	:	SUITE 101
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-2688
Country	:	US
Telephone Number	:	630-718-0200
Fax Number	:	630-718-0900

Provider Business Practice Location Address
First Line	:	433 VICTORIA LN
Second Line	:
City	:	GLENDALE HTS
State	:	IL
Zip	:	60139-4510
Country	:	US
Telephone Number	:	630-797-6368
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN OWNER
Name	:	DR. MUMTAZ A SIDDIQUI
Credential	:	M.D.
Telephone Number	:	630-797-6368

Provider Enumeration Date	:	02/13/2013
Last Update Date	:	02/13/2013

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