Provider Demographics
NPI:1043329394
Name:CARDIOVASCULAR CARE ASSOCIATES S.C.
Entity type:Organization
Organization Name:CARDIOVASCULAR CARE ASSOCIATES S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NARAYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MULAMALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-283-1800
Mailing Address - Street 1:3800 203RD ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1936
Mailing Address - Country:US
Mailing Address - Phone:708-283-1800
Mailing Address - Fax:708-283-8607
Practice Address - Street 1:3800 203RD ST
Practice Address - Street 2:SUITE 209
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1936
Practice Address - Country:US
Practice Address - Phone:708-283-1800
Practice Address - Fax:708-283-8607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200194920AMedicaid
ILH3947OtherRAILROD MEDICARE GROUP NU
IN200194920AMedicaid
IN162930Medicare PIN
IL446990Medicare ID - Type UnspecifiedGROUP NUMBER
IL446990Medicare PIN