MEDICARE: NANI VASCULAR NORTH ASC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician

General Provider Information

NPI Number	:	1568262236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NANI VASCULAR NORTH ASC LLC

Provider Business Mailing Address
First Line	:	120 W 22ND ST
Second Line	:	STE 200
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1563
Country	:	US
Telephone Number	:	630-573-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2055 W ARMY TRAIL RD STE 110N
Second Line	:
City	:	ADDISON
State	:	IL
Zip	:	60101-1478
Country	:	US
Telephone Number	:	630-974-5225
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	NAOMI M CASSIN
Credential	:
Telephone Number	:	630-573-5000

Provider Enumeration Date	:	03/13/2025
Last Update Date	:	02/04/2026

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