Organization
HEART CARE CENTERS OF ILLINOIS, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHYLLIS GEDZUN (PRACTICE MANAGER)
(708) 478-3600
Entity
Organization
Contact information
Practice address
13011 S 104TH AVE, PALOS PARK, IL 60464-1506
(708) 478-3600
Mailing address
13011 S 104TH AVE, SUITE 100, PALOS PARK, IL 60464-1506
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
—
—
207RC0001X
Clinical Cardiac Electrophysiology Physician
—
—
207RI0011X
Interventional Cardiology Physician
—
—
207UN0901X
Nuclear Cardiology Physician
207R00000X
IL
208600000X
Surgery Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1508810086
GROUP NPI
IL
01
—
236550
MEDICARE PTAN
—
01
—
236551
MEDICARE PTAN
IL
01
—
416810
MEDICARE PTAN
IL
Enumeration date
05/20/2014
Last updated
05/20/2014
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