Provider Demographics
NPI:1902079718
Name:NORTH-WEST CARDIO-VASCULAR CENTER
Entity Type:Organization
Organization Name:NORTH-WEST CARDIO-VASCULAR CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIROSLAW
Authorized Official - Middle Name:T
Authorized Official - Last Name:SOCHANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-622-5200
Mailing Address - Street 1:3115 N HARLEM AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-4684
Mailing Address - Country:US
Mailing Address - Phone:773-622-5200
Mailing Address - Fax:773-889-6571
Practice Address - Street 1:3115 N HARLEM AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4684
Practice Address - Country:US
Practice Address - Phone:773-622-5200
Practice Address - Fax:773-889-6571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-12
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0362097687207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE35524Medicare UPIN