Organization
CARDIOSPECIALISTS GROUP, LTD
Active
Other names
Midwest Arrhythmia Consultants
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRAD L SUPRENANT DO (PRESIDENT/MANAGING PARTNER)
(219) 319-0300
Entity
Organization
Contact information
Practice address
2150 GETTLER ST, SUITE 122, DYER, IN 46311-2380
(219) 319-0300
(219) 440-7475
Mailing address
39649 TREASURY CTR, CHICAGO, IL 60694-9000
(219) 319-0300
(219) 440-7475
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
—
—
207RC0001X
Clinical Cardiac Electrophysiology Physician
—
—
207RI0011X
Interventional Cardiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CA4855
RR MEDICARE
IN
01
—
CN0895
RR MEDICARE
IL
01
—
DA0548
RR MEDICARE
IL
Enumeration date
05/08/2006
Last updated
05/10/2016
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