Healthcare Provider Details

I. General information

NPI: 1245638998
Provider Name (Legal Business Name): ATLANTA LASER VEIN INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2014
Last Update Date: 12/22/2022
Certification Date: 12/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 E PIEDMONT RD SUITE 104
MARIETTA GA
30062-4758
US

IV. Provider business mailing address

PO BOX 1602
NORTHBROOK IL
60065-1602
US

V. Phone/Fax

Practice location:
  • Phone: 847-305-3346
  • Fax: 224-246-8042
Mailing address:
  • Phone: 847-593-8460
  • Fax:

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