Organization
LINCOLN PARK CARDIOVASCULAR AND THORACIC SURGEONS, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT H BREYER MD (PRESIDENT)
(773) 477-4343
Entity
Organization
Contact information
Practice address
2800 N SHERIDAN RD, SUITE 209, CHICAGO, IL 60657-6156
(773) 477-4343
(773) 477-5088
Mailing address
1095 PAYSPHERE CIR, CHICAGO, IL 60674-6156
(773) 477-4343
(773) 477-5088
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036047470
—
IL
05
—
036078287
—
IL
01
—
060007657
RAILROAD MEDICARE
IL
01
—
060028585
RAILROAD MEDICARE
IL
01
—
31603025
BLUECROSS BLUESHIELD
IL
01
—
968650
MEDICARE PROVIDER
IL
01
—
CA6737
RAILROAD MEDICARE
IL
Enumeration date
01/08/2007
Last updated
02/05/2010
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