Healthcare Provider Details

I. General information

NPI: 1154477990
Provider Name (Legal Business Name): MIDWEST VASCULAR CENTER NORTH SUBURBAN S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 COMPASS RD SUITE 110
GLENVIEW IL
60026-8004
US

IV. Provider business mailing address

2601 COMPASS RD SUITE 110
GLENVIEW IL
60026-8004
US

V. Phone/Fax

Practice location:
  • Phone: 847-724-4141
  • Fax: 847-724-4154
Mailing address:
  • Phone: 847-724-4141
  • Fax: 847-724-4154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State

VIII. Authorized Official

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