Provider Demographics
NPI:1396799862
Name:CARDIOVASCULAR SERVICE ASSOCIATES
Entity type:Organization
Organization Name:CARDIOVASCULAR SERVICE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BOHDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FEDIRKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-585-7505
Mailing Address - Street 1:PO BOX 388309
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-8309
Mailing Address - Country:US
Mailing Address - Phone:773-585-7505
Mailing Address - Fax:773-585-7507
Practice Address - Street 1:7425 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-2139
Practice Address - Country:US
Practice Address - Phone:773-585-7505
Practice Address - Fax:773-585-7507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213079Medicare PIN