Provider Demographics
NPI:1215984745
Name:CHICAGO CARDIO DIAGNOSTICS, L.L.C.
Entity type:Organization
Organization Name:CHICAGO CARDIO DIAGNOSTICS, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:L
Authorized Official - Last Name:DESROSIERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-995-8001
Mailing Address - Street 1:PO BOX 59111
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60159-0111
Mailing Address - Country:US
Mailing Address - Phone:847-995-8001
Mailing Address - Fax:
Practice Address - Street 1:270 WILLOBY CT
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-2161
Practice Address - Country:US
Practice Address - Phone:847-995-8001
Practice Address - Fax:847-413-0922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-29
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL5532-4134261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001635632OtherBC/BS OF IL PROVIDER #
IL212835Medicare ID - Type UnspecifiedLOCALITY 15 IDTF PROVIDER
IL212834Medicare ID - Type UnspecifiedCOOK COUNTY IDTF PROVIDER