Healthcare Provider Details

I. General information

NPI: 1316085830
Provider Name (Legal Business Name): PREFERRED VASCULAR DIAGNOSTICS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 12/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 S. DRYDEN PL
ARLINGTON HEIGHTS IL
60004-6369
US

IV. Provider business mailing address

425 S FINLEY RD
LOMBARD IL
60148-2428
US

V. Phone/Fax

Practice location:
  • Phone: 630-209-9161
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XC2903X
TaxonomyVascular Specialist/Technologist Cardiovascular
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH LANGWORTHY
Title or Position: OWNER
Credential: RVT
Phone: 630-209-9161