Healthcare Provider Details

I. General information

NPI: 1437825866
Provider Name (Legal Business Name): USA VEIN CLINICS OF MIAMI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 95TH AVE N
PINELLAS PARK FL
33782-3544
US

IV. Provider business mailing address

PO BOX 971
NORTHBROOK IL
60065-0971
US

V. Phone/Fax

Practice location:
  • Phone: 813-773-0988
  • Fax:
Mailing address:
  • Phone: 847-593-8460
  • Fax: 224-235-4652

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
Credential: M.D.
Phone: 847-593-8460