Healthcare Provider Details

I. General information

NPI: 1154602043
Provider Name (Legal Business Name): MVC-CHICAGO, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 N LAKE SHORE DR SUITE 104
CHICAGO IL
60673-1050
US

IV. Provider business mailing address

2001 BUTTERFIELD RD SUITE 100
DOWNERS GROVE IL
60515-1050
US

V. Phone/Fax

Practice location:
  • Phone: 312-819-5901
  • Fax:
Mailing address:
  • Phone: 630-322-9126
  • Fax: 630-322-9128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JAMES WRIGHT
Title or Position: PRESIDENT
Credential: MD
Phone: 630-322-9126