Provider Demographics
NPI:1639267081
Name:KISHWAUKEE CARDIOLOGY ASSOCIATES, LTD.
Entity type:Organization
Organization Name:KISHWAUKEE CARDIOLOGY ASSOCIATES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAGDISH
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:1815-786-7076
Mailing Address - Street 1:2530 HAUSER ROSS DR
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3162
Mailing Address - Country:US
Mailing Address - Phone:815-748-7076
Mailing Address - Fax:815-748-7070
Practice Address - Street 1:2530 HAUSER ROSS DR
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3162
Practice Address - Country:US
Practice Address - Phone:815-748-7076
Practice Address - Fax:815-748-7070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1891704037Medicaid
IL1891704037Medicaid