Healthcare Provider Details

I. General information

NPI: 1932426863
Provider Name (Legal Business Name): LIFELINE VASCULAR ACCESS NETWORK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

THREE HAWTHORN PARKWAY SUITE 410
VERNON HILLS IL
60061-1450
US

IV. Provider business mailing address

THREE HAWTHORN PARKWAY SUITE 410
VERNON HILLS IL
60061-1450
US

V. Phone/Fax

Practice location:
  • Phone: 847-388-2001
  • Fax: 847-388-2020
Mailing address:
  • Phone: 847-388-2001
  • Fax: 847-388-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD NEE
Title or Position: VP / GENERAL MANAGER
Credential:
Phone: 847-388-2055