Healthcare Provider Details

I. General information

NPI: 1649861451
Provider Name (Legal Business Name): GENERATION VEIN CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 N MILWAUKEE AVE STE 105
NILES IL
60714-3124
US

IV. Provider business mailing address

7800 N MILWAUKEE AVE STE 105
NILES IL
60714-3124
US

V. Phone/Fax

Practice location:
  • Phone: 224-888-3033
  • Fax:
Mailing address:
  • Phone: 224-888-3033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. YEVGENY BULBIN
Title or Position: CMO
Credential: MD
Phone: 847-845-6465