Healthcare Provider Details

I. General information

NPI: 1396147138
Provider Name (Legal Business Name): USA VEIN CLINICS OF MIAMI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2014
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 E HALLANDALE BEACH BLVD STE B
HALLANDALE BEACH FL
33009-4621
US

IV. Provider business mailing address

PO BOX 971
NORTHBROOK IL
60065-0971
US

V. Phone/Fax

Practice location:
  • Phone: 546-883-9689
  • Fax:
Mailing address:
  • Phone: 847-305-3346
  • Fax: 224-246-8042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: YAN KATSNELSON
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 847-593-8460