Organization
TALLGRASS CARDIOLOGY SERVICES SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HERSHEL LISTON WIX JR. M.D. (PRESIDENT)
(815) 937-9370
Entity
Organization
Contact information
Practice address
475 BROWN BLVD, SUITE 103, BOURBONNAIS, IL 60914-2325
(815) 937-9370
(815) 937-2700
Mailing address
475 BROWN BLVD, SUITE 103, BOURBONNAIS, IL 60914-2325
(815) 937-9370
(815) 937-2700
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
036051497
IL
Other
Enumeration date
10/28/2010
Last updated
01/11/2011
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