Healthcare Provider Details

I. General information

NPI: 1871160879
Provider Name (Legal Business Name): MOUNT SINAI VASCULAR INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 ALTON RD STE 2071
MIAMI BEACH FL
33140-2948
US

IV. Provider business mailing address

PO BOX 527824
MIAMI FL
33152-7824
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-2906
  • Fax: 305-674-3927
Mailing address:
  • Phone: 305-535-3349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. WAYNE CHUTKAN
Title or Position: VP OF FINANCE
Credential:
Phone: 305-674-2662