Healthcare Provider Details

I. General information

NPI: 1841654423
Provider Name (Legal Business Name): NELLESTEIN VEIN INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 VILLAGE DR
SAINT JOSEPH MO
64506-2457
US

IV. Provider business mailing address

1341 VILLAGE DR
SAINT JOSEPH MO
64506-2457
US

V. Phone/Fax

Practice location:
  • Phone: 816-291-4149
  • Fax: 816-897-3969
Mailing address:
  • Phone: 816-291-4149
  • Fax: 816-897-3969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number StateMO

VIII. Authorized Official

Name: MICHAEL E. NELLESTEIN
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 816-291-4149