Healthcare Provider Details

I. General information

NPI: 1932658622
Provider Name (Legal Business Name): CENTER FOR VEIN RESTORATION KY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2016
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2054 E PARRISH AVE STE A
OWENSBORO KY
42303-1448
US

IV. Provider business mailing address

7474 GREENWAY CENTER DR SUITE 1000
GREENBELT MD
20770-3504
US

V. Phone/Fax

Practice location:
  • Phone: 855-830-8346
  • Fax: 855-830-8346
Mailing address:
  • Phone: 240-965-3258
  • Fax: 240-473-4323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: SANJIV LAKHANPAL
Title or Position: PRESIDENT
Credential: MD
Phone: 855-830-8346