Healthcare Provider Details

I. General information

NPI: 1427013390
Provider Name (Legal Business Name): VASCULAR DIAGNOSTICS, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 02/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 DEMPSTER ST SUITE 105
PARK RIDGE IL
60068-1109
US

IV. Provider business mailing address

1600 DEMPSTER ST SUITE 105
PARK RIDGE IL
60068-1109
US

V. Phone/Fax

Practice location:
  • Phone: 847-298-7876
  • Fax: 847-298-7886
Mailing address:
  • Phone: 847-298-7876
  • Fax: 847-298-7886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XC2903X
TaxonomyVascular Specialist/Technologist Cardiovascular
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY BUCKMAN
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: M.D.
Phone: 847-298-7876