Healthcare Provider Details

I. General information

NPI: 1144816976
Provider Name (Legal Business Name): ATLAS VEIN CARE SPECIALISTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 HIGHWAY A1A STE 110
INDIAN HARBOUR BEACH FL
32937-3581
US

IV. Provider business mailing address

2636 MCDONALD TER
MOUNT DORA FL
32757-4715
US

V. Phone/Fax

Practice location:
  • Phone: 321-978-8348
  • Fax:
Mailing address:
  • Phone: 850-554-8182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ZAHER ELMIR
Title or Position: PRESIDENT
Credential: MD
Phone: 321-978-8348