Healthcare Provider Details

I. General information

NPI: 1497081863
Provider Name (Legal Business Name): UNITED VASCULAR SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2009
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9730 S WESTERN AVE STE B
EVERGREEN PARK IL
60805-2814
US

IV. Provider business mailing address

PO BOX 7412452
CHICAGO IL
60674-2452
US

V. Phone/Fax

Practice location:
  • Phone: 888-402-0202
  • Fax: 888-860-2960
Mailing address:
  • Phone: 248-607-0037
  • Fax: 734-462-0344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number042.619557
License Number StateIL

VIII. Authorized Official

Name: KIMBERLY MILLER
Title or Position: DIRECTOR OF RCM
Credential:
Phone: 248-331-7908