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General NPI Number Information
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NPI Number | 1053668228
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Entity Type | Organization
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Legal Business Name | LIFELINE VASCULAR CENTER OF SOUTH ORLANDO, LLC
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Dates
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Enumeration Date | 08/07/2012
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Last Update Date | 08/07/2012
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Provider Practice Location Address
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Address Line | 1511 SLIGH BLVD SUITE A
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City | ORLANDO
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State | FL
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Zip | 32806-3959
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Country | US
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Telephone | 847-949-3845
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Fax | 866-408-5072
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Provider Business Mailing Address
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Address Line | 3 W HAWTHORN PKWY SUITE 410
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City | VERNON HILLS
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State | IL
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Zip | 60061-1446
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Country | US
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Telephone | 847-388-2001
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Fax | 847-388-2020
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Authorized Official
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Title or Position | CHIEF ACCOUNTING OFFICER
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Name | JAMES HILGER
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Credential |
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Telephone | 253-280-9501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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