Healthcare Provider Details

I. General information

NPI: 1265345474
Provider Name (Legal Business Name): VANTIS HEALTH LOUISIANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9211 FOREST HILL AVE STE 200
RICHMOND VA
23235-6877
US

IV. Provider business mailing address

2634 PATRIOT BLVD STE C
GLENVIEW IL
60026-8024
US

V. Phone/Fax

Practice location:
  • Phone: 224-353-0333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. MINA KHAROT PAIMAN
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 224-353-0333