Organization
PREVENTIVE CARDIOVASCULAR SERVICES SC
Active
Organization
PREVENTIVE CARDIOVASCULAR SERVICES SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALAN JACKSON MD (PRESIDENT)
(708) 479-6522
Entity
Organization
Contact information
Practice address
356 W SUPERIOR ST FL 2, CHICAGO, IL 60654-3416
(312) 932-0300
Mailing address
PO BOX 187, TINLEY PARK, IL 60477-0187
(708) 479-6522
(708) 479-6597
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
036081595
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036081595
—
IL
Enumeration date
12/01/2006
Last updated
09/18/2009
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