Provider Demographics
NPI:1871743468
Name:CHICAGO CARDIOVASCULAR THORACIC SURGICAL SPECIALISTS PC
Entity type:Organization
Organization Name:CHICAGO CARDIOVASCULAR THORACIC SURGICAL SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:KRONON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-588-0550
Mailing Address - Street 1:3937 N TROY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3407
Mailing Address - Country:US
Mailing Address - Phone:773-588-0550
Mailing Address - Fax:773-539-1241
Practice Address - Street 1:1044 N FRANCISCO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2743
Practice Address - Country:US
Practice Address - Phone:773-292-8388
Practice Address - Fax:773-539-1241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1628678OtherBCBS
IL1628678OtherBCBS