Provider Demographics
NPI:1699962696
Name:CLINICAL AND INTERVENTIONAL CARDIOLOGY
Entity type:Organization
Organization Name:CLINICAL AND INTERVENTIONAL CARDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED MEDICAL ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:GILPIN
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:847-676-1333
Mailing Address - Street 1:9669 KENTON AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1266
Mailing Address - Country:US
Mailing Address - Phone:847-676-1333
Mailing Address - Fax:847-676-1727
Practice Address - Street 1:9669 KENTON AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1266
Practice Address - Country:US
Practice Address - Phone:847-676-1333
Practice Address - Fax:847-676-1727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1635694OtherBCBS
IL212343Medicare PIN