Healthcare Provider Details

I. General information

NPI: 1467123794
Provider Name (Legal Business Name): CHICAGO ENDOVASCULAR CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3724 WHIRLAWAY DR
NORTHBROOK IL
60062-6314
US

IV. Provider business mailing address

182 INDUSTRIAL RD
GLEN ROCK PA
17327-8626
US

V. Phone/Fax

Practice location:
  • Phone: 717-759-5148
  • Fax:
Mailing address:
  • Phone: 717-759-5148
  • Fax: 717-759-5435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ISRAEL SCHUR
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 717-759-5148