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NPI Code Detail

MEDICARE: VASCULAR CLINIC PLLC

MEDICARE: VASCULAR CLINIC PLLC
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
12086S0129XVascular Surgery Physician

General Provider Information

NPI Number : 1922896240
Entity Type Code : Organization
Provider Name (Legal Business Name) : VASCULAR CLINIC PLLC
Provider Business Mailing Address
First Line : 775 PRIMERA BLVD STE 1031
Second Line :
City : LAKE MARY
State : FL
Zip : 32746-2190
Country : US
Telephone Number : 561-957-7555
Fax Number :
Provider Business Practice Location Address
First Line : 775 PRIMERA BLVD STE 1031
Second Line :
City : LAKE MARY
State : FL
Zip : 32746-2190
Country : US
Telephone Number : 561-957-7555
Fax Number :
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : DR. KHALIL MASABNI
Credential : MD
Telephone Number : 561-957-7555
Provider Enumeration Date : 04/28/2025
Last Update Date : 01/04/2026

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Directions to “VASCULAR CLINIC PLLC ” Practice Location

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