Provider Demographics
NPI:1982436507
Name:HEART AND VASCULAR SPECIALISTS LLC
Entity type:Organization
Organization Name:HEART AND VASCULAR SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:TAREK
Authorized Official - Middle Name:MOHAMAD
Authorized Official - Last Name:AHDAB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-529-7109
Mailing Address - Street 1:2045 W GRAND AVE STE B713681
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-1576
Mailing Address - Country:US
Mailing Address - Phone:708-529-7109
Mailing Address - Fax:708-741-3025
Practice Address - Street 1:10378 SOUTH . HARLEM AVE
Practice Address - Street 2:CARDIOVASCULAR SUITE
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465
Practice Address - Country:US
Practice Address - Phone:708-925-7109
Practice Address - Fax:708-741-3025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty