Healthcare Provider Details

I. General information

NPI: 1245875061
Provider Name (Legal Business Name): USA VASCULAR CENTER OF DALLAS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2019
Last Update Date: 11/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 W FM 544 STE B
WYLIE TX
75098-4931
US

IV. Provider business mailing address

PO BOX 971
NORTHBROOK IL
60065-0971
US

V. Phone/Fax

Practice location:
  • Phone: 847-593-8460
  • Fax: 224-235-4652
Mailing address:
  • Phone: 224-318-0118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: YAN KATSNELSON
Title or Position: CEO / PRESIDENT
Credential: MD
Phone: 847-593-8460