CARDIOTHORACIC & VASCULAR SURGICAL ASSOCIATES S C

Provider Demographics

• NPI: 1780679407
• Name: CARDIOTHORACIC & VASCULAR SURGICAL ASSOCIATES S C
• Entity type: Organization
• Organization Name: CARDIOTHORACIC & VASCULAR SURGICAL ASSOCIATES S C
• Authorized Official - Title/Position: PRESIDENT/SHAREHOLDER
• Authorized Official - Prefix: DR
• Authorized Official - First Name: PATROKLOS
• Authorized Official - Middle Name: STEVEN
• Authorized Official - Last Name: PAPPAS
• Authorized Official - Credentials: MD
• Authorized Official - Phone: 708-346-4040
• Mailing Address - Street 1: 1901 S MEYERS RD STE 158
• Mailing Address - City: OAKBROOK TERRACE
• Mailing Address - State: IL
• Mailing Address - Zip Code: 60181-5278
• Mailing Address - Country: US
• Mailing Address - Phone: 708-346-4044
• Mailing Address - Fax: 708-346-3287
• Practice Address - Street 1: 4400 W 95TH ST STE 308
• Practice Address - City: OAK LAWN
• Practice Address - State: IL
• Practice Address - Zip Code: 60453-2660
• Practice Address - Country: US
• Practice Address - Phone: 708-346-4040
• Practice Address - Fax: 708-346-3287
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2005-09-19
• Last Update Date: 2024-11-06

Provider Licenses

State	License ID	Taxonomies
		204F00000X, 2086S0129X, 363AS0400X, 363L00000X, 208G00000X
IN	50003815A	208G00000X, 363AM0700X, 363AS0400X
IL	042006976	363AM0700X, 363AS0400X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	208G00000X	Allopathic & Osteopathic Physicians	Thoracic Surgery (Cardiothoracic Vascular Surgery)		Group - Multi-Specialty
No	204F00000X	Allopathic & Osteopathic Physicians	Transplant Surgery		Group - Multi-Specialty
No	2086S0129X	Allopathic & Osteopathic Physicians	Surgery	Vascular Surgery	Group - Multi-Specialty
No	363AS0400X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant	Surgical	Group - Multi-Specialty
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Multi-Specialty
No	363AM0700X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant	Medical	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
IL	304044982001	Medicaid
IL	01618941	Other	BLUE CROSS BLUE SHIELD
IL	01618941	Other	BLUE CROSS BLUE SHIELD
IN	200060980A	Medicaid
IN	200060980D	Medicaid
IN	200060980B	Medicaid
IN	200060980F	Medicaid
WI	1780679407	Medicaid
MI	1780679407	Medicaid
IL	01618941	Other	BLUE CROSS BLUE SHIELD
WI	WI2355	Medicare PIN
IN	200060980A	Medicaid
IN	200060980D	Medicaid
IL	0=========6045301	Medicaid
IL	DD6896	Medicare PIN
IN	408430	Medicare PIN
IL	535550	Medicare PIN
IL	01618941	Other	BLUE CROSS BLUE SHIELD
MI	1780679407	Medicaid
WI	1780679407	Medicaid
IL	CN0653	Medicare PIN