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Organization
ILLINOIS CARDIOVASCULAR & THORACIC SURGERY, LTD
Active
Organization
ILLINOIS CARDIOVASCULAR & THORACIC SURGERY, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLEN B SMITH M.D. (CHIREF OPERATIONS OFFICER)
(309) 662-5506
Entity
Organization
Contact information
Practice address
1505 EASTLAND DR, SUITE 210, BLOOMINGTON, IL 61701-7906
(309) 662-5506
(309) 662-5443
Mailing address
1505 EASTLAND DR, SUITE 210, BLOOMINGTON, IL 61701-7906
(309) 662-5506
(309) 662-5443
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
—
NULL
207RC0000X
Cardiovascular Disease Physician
—
—
207RI0011X
Interventional Cardiology Physician
—
NULL
207RI0011X
Interventional Cardiology Physician
—
—
207UN0901X
Nuclear Cardiology Physician
—
NULL
207UN0901X
Nuclear Cardiology Physician
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
NULL
2085R0204X
Vascular & Interventional Radiology Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
NULL
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
Other
Enumeration date
05/04/2006
Last updated
04/24/2012
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