Healthcare Provider Details

I. General information

NPI: 1649026196
Provider Name (Legal Business Name): DANADA VEIN CARE SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 DANADA SQ W
WHEATON IL
60189-2041
US

IV. Provider business mailing address

180 DANADA SQ W
WHEATON IL
60189-2041
US

V. Phone/Fax

Practice location:
  • Phone: 630-474-2600
  • Fax: 630-474-2601
Mailing address:
  • Phone: 630-474-2600
  • Fax: 630-474-2601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State

VIII. Authorized Official

Name: SEAN MCWILLIAMS
Title or Position: OWNER
Credential: MD
Phone: 630-474-2600