Provider Demographics
NPI:1174079883
Name:CARDINAL TECHNICAL SC
Entity type:Organization
Organization Name:CARDINAL TECHNICAL SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMJAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SAFVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:855-200-8262
Mailing Address - Street 1:7000 W PALMETTO PARK RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3424
Mailing Address - Country:US
Mailing Address - Phone:855-200-8262
Mailing Address - Fax:
Practice Address - Street 1:208 LASALLE STREET
Practice Address - Street 2:SUITE 214
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604
Practice Address - Country:US
Practice Address - Phone:855-200-8262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036099445174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty