Healthcare Provider Details

I. General information

NPI: 1639794597
Provider Name (Legal Business Name): REGION VEIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 06/22/2020
Certification Date: 06/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 RIDGE RD STE C
MUNSTER IN
46321-1756
US

IV. Provider business mailing address

931 RIDGE RD STE C
MUNSTER IN
46321-1756
US

V. Phone/Fax

Practice location:
  • Phone: 219-595-3095
  • Fax: 219-881-8776
Mailing address:
  • Phone: 219-595-3095
  • Fax: 219-881-8776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DEMETRIOS KARAMICHOS
Title or Position: OWNER
Credential: MD
Phone: 219-595-3095