Healthcare Provider Details

I. General information

NPI: 1053511840
Provider Name (Legal Business Name): SW SUBURBAN - MIDWEST VASCULAR CENTER, S. C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10755 W 143RD ST
ORLAND PARK IL
60462-1900
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 630-322-9126
  • Fax:
Mailing address:
  • Phone: 630-322-9126
  • Fax: 630-995-7965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State

VIII. Authorized Official

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