Provider Demographics
NPI:1871574863
Name:SOUTH SUBURBAN CARDIOLOGY LTD
Entity type:Organization
Organization Name:SOUTH SUBURBAN CARDIOLOGY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IMTIAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-799-0180
Mailing Address - Street 1:17901 GOVERNORS HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-1144
Mailing Address - Country:US
Mailing Address - Phone:708-799-0180
Mailing Address - Fax:708-799-3839
Practice Address - Street 1:17901 GOVERNORS HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1144
Practice Address - Country:US
Practice Address - Phone:708-799-0180
Practice Address - Fax:708-799-3839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCA0145OtherRAILROAD MEDICARE
ILCB0037OtherRAILROAD MEDICARE
ILCB1134OtherRR MEDICARE
ILCB1134OtherRR MEDICARE
IL605820Medicare ID - Type Unspecified