Basic Information
| Provider Information | |||||||||
| NPI: | 1316998578 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST SUBURBAN CARDIOLOGISTS, LTD. | ||||||||
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| OtherOrganizationName: | HEART AND VASCULAR OF ILLINOIS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 S FRONTAGE RD | ||||||||
| Address2: | SUITE 325 | ||||||||
| City: | WOODRIDGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605174903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7738809722 | ||||||||
| FaxNumber: | 7738809723 | ||||||||
| Practice Location | |||||||||
| Address1: | 3118 N ASHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606573014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7738809722 | ||||||||
| FaxNumber: | 7738809723 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2006 | ||||||||
| LastUpdateDate: | 12/21/2010 | ||||||||
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| AuthorizedOfficialLastName: | BADDI | ||||||||
| AuthorizedOfficialFirstName: | AJAY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 7738809722 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0001X | 060000983 | IL | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | 363L00000X | 06000983 | IL | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207RC0000X | 060000983 | IL | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 1616378 | 01 | IL | BCBS | OTHER |