Provider Demographics
NPI:1992933527
Name:ILLINOIS CARDIOTHORACIC SURGEONS, LLC
Entity type:Organization
Organization Name:ILLINOIS CARDIOTHORACIC SURGEONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:LAGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:1630-408-2977
Mailing Address - Street 1:1111 SUPERIOR ST
Mailing Address - Street 2:STE. 405
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-4138
Mailing Address - Country:US
Mailing Address - Phone:163-040-8297
Mailing Address - Fax:184-745-5041
Practice Address - Street 1:1111 SUPERIOR ST
Practice Address - Street 2:STE. 405
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-4138
Practice Address - Country:US
Practice Address - Phone:163-040-8297
Practice Address - Fax:184-745-5041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty