Provider Demographics
NPI:1972614246
Name:ELGIN CARDIAC SURGERY SC
Entity type:Organization
Organization Name:ELGIN CARDIAC SURGERY SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:STEIMLE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:847-717-3265
Mailing Address - Street 1:1600 N RANDALL RD STE 355
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-7805
Mailing Address - Country:US
Mailing Address - Phone:847-717-3265
Mailing Address - Fax:847-695-1954
Practice Address - Street 1:1600 N RANDALL RD STE 355
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-7805
Practice Address - Country:US
Practice Address - Phone:847-717-3265
Practice Address - Fax:847-695-1954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042-005785208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL668650Medicare PIN