MIDWEST PEDIATRIC CARDIOLOGY, P.C. (NPI# 1962483669) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962483669 |
| Entity Type | Organization |
| Organization Name | MIDWEST PEDIATRIC CARDIOLOGY, P.C. |
| Practice Address |
4440 W 95th St Oak Lawn IL 60453-2600 |
| Mailing Address |
621 Plainfield Rd #105 Willow Brook IL 60527-5343 |
| Practice Telephone | 7086845580 |
| Practice Fax Number | 7086844068 |
| Mailing Telephone | 6303219811 |
| Mailing Fax Number | 6303219813 |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2007-09-14 |
| Authorized Official Name | DR. DAVID ROBERSON (PRESIDENT) |
| Authorized Official Telephone | 7086845580 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0202X |
Pediatrics Specialization: Pediatric Cardiology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| BCBS OF ILLINOIS | 1617609 | 01 |
| Street Address |
4440 W 95TH ST |
| City | OAK LAWN |
| State | IL |
| Zip Code | 60453-2600 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902805666 | Kenneth S. Toth | Anesthesiology | 4440 W 95th St, Oak Lawn, IL 60453-2600 | 2005-07-15 |
| 1821697392 | Marissa Vavra | Occupational Therapist | 4440 W 95th St, Oak Lawn, IL 60453-2600 | 2020-10-25 |
| 1215535638 | Jarrod Siek Georgacakis | Nurse Practitioner | 4440 W 95th St, Oak Lawn, IL 60453-2600 | 2020-10-16 |
| 1396350708 | Crystal Oehmen | Radiology | 4440 W 95th St, Oak Lawn, IL 60453-2600 | 2020-09-11 |
| 1255943999 | Kristen Michele Hill | Nurse Practitioner | 4440 W 95th St, Oak Lawn, IL 60453-2600 | 2020-08-22 |
| 1033735295 | Thomas Panicucci | Registered Nurse | 4440 W 95th St, Oak Lawn, IL 60453-2600 | 2020-06-23 |
| 1538785407 | Amanda Thompson | Nurse Practitioner | 4440 W 95th St, Oak Lawn, IL 60453-2600 | 2020-06-17 |
| 1508481250 | Amy Marie Fader | Student in an Organized Health Care Education/Training Program | 4440 W 95th St, Oak Lawn, IL 60453-2600 | 2020-06-09 |
| 1528680139 | Nader Hamzeh Darwish | Student in an Organized Health Care Education/Training Program | 4440 W 95th St, Oak Lawn, IL 60453-2600 | 2020-05-18 |
| 1003438920 | Anna Manilla | Speech-Language Pathologist | 4440 W 95th St, Oak Lawn, IL 60453-2600 | 2020-05-13 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659995231 | Natalia Zero | Student in an Organized Health Care Education/Training Program | 4440 W 95th St, Rm 131 North, Oak Lawn, IL 60453 | 2020-05-30 |
| 1114554300 | Sylvia Maria Chlebek | Student in an Organized Health Care Education/Training Program | Advocate Christ Medical Center 4440 W. 95th St., Rm 131 North, Oak Lawn, IL 60453 | 2020-03-26 |
| 1972066751 | Amanda Mroczek | Family Medicine | 9555 52nd Avenue, Suite F, Oak Lawn, IL 60453 | 2019-04-09 |
| 1013479955 | Leah Rae Prager | Physician Assistant | 4400 W. 95th St., Attn: Pediatric General Surgery, Oak Lawn, IL 60453 | 2019-04-01 |
| 1659833473 | Chelsea Sumida Gipson | Family Medicine | 9555 South 52nd Avenue, Suite F, Oak Lawn, IL 60453 | 2019-04-01 |
| 1518427418 | Robert Lindgren | Family Medicine | 9555 S. 52nd Ave., Suite F, Oak Lawn, IL 60453 | 2019-03-25 |
| 1154886695 | Stephanie Anne Comer | Social Worker | 10102 South Cicero Avenue, Suite C, Oak Lawn, IL 60453 | 2019-02-08 |
| 1700360070 | Brian L Lee | Counselor | 8938 S Ridgeland Avenue Suite 100, Oak Lawn, IL 60453 | 2018-09-21 |
| 1679085245 | International Dental of Oak Lawn | Clinic/Center | 9539 S Cicero Ave, Oak Lawn, IL 60453 | 2017-11-03 |
| 1124538301 | Kavitha Rajendran | Physician Assistant | 5851 W. 95th Street, Suite 300, Oak Lawn, IL 60453 | 2017-10-02 |
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| Taxonomy Code | 2080P0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Cardiology |
| A pediatric cardiologist provides comprehensive care to patients with cardiovascular problems. This specialist is skilled in selecting, performing and evaluating the structural and functional assessment of the heart and blood vessels, and the clinical evaluation of cardiovascular disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pediatrics. The Certification is no longer offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023345170 | Naveen Imran | Pediatrics | 4440 W 95th St, Oak Lawn, IL 60453-2600 | 2009-11-11 |
| 1831380583 | Imran Sajan | Pediatrics | 4440 W 95th Street, Oak Lawn, IL 60453 | 2007-08-07 |
| 1942414875 | David Gamboa | Pediatrics | 4440 W 95th St, Oak Lawn, IL 60453-2600 | 2007-05-10 |
| 1801912621 | Rupali Gandhi | Pediatrics | 4440 W 95th St, Oak Lawn, IL 60453-2600 | 2007-03-22 |
| 1497870117 | Tania L Saroli | Pediatrics | 4440 W 95th St, Oak Lawn, IL 60453 | 2007-03-20 |
| 1174673123 | Frank J Zimmerman | Pediatrics | 4440 W 95th St, Oak Lawn, IL 60453-2600 | 2007-01-11 |
| 1629023247 | Andrew J Griffin | Pediatrics | 4440 W 95th St, Oak Lawn, IL 60453-2600 | 2006-05-23 |
| 1689655391 | Andrew Henry Vanbergen | Pediatrics | 4440 W 95th St, Oak Lawn, IL 60453-2600 | 2005-11-09 |
| 1649251364 | Tarek Husayni | Pediatrics | 4440 W 95th St, Oak Lawn, IL 60453-2600 | 2005-11-09 |
| 1235110958 | Earl Philip Ow | Pediatrics | 4440 W 95th St, Oak Lawn, IL 60453-2600 | 2005-11-09 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.