Healthcare Provider Details

I. General information

NPI: 1629813787
Provider Name (Legal Business Name): NANI VASCULAR NORTH ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2024
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 W ARMY TRAIL RD STE 110N
ADDISON IL
60101-1478
US

IV. Provider business mailing address

120 W 22ND STREET
ADDISON IL
60523
US

V. Phone/Fax

Practice location:
  • Phone: 630-573-5000
  • Fax:
Mailing address:
  • Phone: 630-573-5000
  • Fax: 630-368-0280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BRIAN O'DEA
Title or Position: CEO
Credential:
Phone: 630-974-5225