Organization
ILLINOIS CARDIAC SURGERY ASSOCIATES SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DALE M GEISS MD (PRESIDENT)
(309) 674-2002
Entity
Organization
Contact information
Practice address
515 NE GLEN OAK, SUITE 105, PEORIA, IL 61603-3167
(309) 674-2002
(309) 624-9898
Mailing address
515 NE GLEN OAK, SUITE 105, PEORIA, IL 61603-3167
(309) 674-2002
(309) 624-9898
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07215075
BLUE SHEILD
IL
Enumeration date
09/28/2006
Last updated
05/06/2014
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