=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023751351
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VEIN CLINICS OF TRISTATE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2022
-----------------------------------------------------
Last Update Date | 11/16/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8044 MONTGOMERY RD STE. 525
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45236-2925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-793-9999
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8044 MONTGOMERY RD STE. 525
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45236-2925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-793-9999
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TAREK ANJARI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 513-793-9999
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 202K00000X
-----------------------------------------------------
Taxonomy Name | Phlebology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------