# PEDIATRIC HEART SURGERY ASSOCIATES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114166295
- **Authorized official:** DR. HANI A HENNEIN MD (PRESIDENT)
- **Authorized official phone:** (630) 860-0035

## Contact information

- **Practice address:** 311 N WALNUT AVE, SUITE 100, WOOD DALE, IL 60191-1566
- **Practice address phone:** (630) 860-0035
- **Practice address fax:** (630) 860-5262
- **Mailing address:** 6547 N AVONDALE AVE, \#001, CHICAGO, IL 60631-1573
- **Mailing address phone:** (773) 775-1622
- **Mailing address fax:** (773) 775-1693

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | 036-099190 | IL | Yes |

## Other

- **Enumeration date:** 02/12/2009
- **Last updated:** 02/12/2009