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General NPI Number Information
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NPI Number | 1205471877
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Entity Type | Organization
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Legal Business Name | VEIN CLINICS OF ILLINOIS S.C.
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Dates
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Enumeration Date | 11/07/2019
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Last Update Date | 11/14/2019
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Provider Practice Location Address
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Address Line | 1212 N LA SALLE DR STE 100
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City | CHICAGO
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State | IL
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Zip | 60610-2379
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Country | US
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Telephone | 347-405-8160
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Fax | 347-405-8161
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Provider Business Mailing Address
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Address Line | 244 MADISON AVE # 1120
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City | NEW YORK
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State | NY
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Zip | 10016-2817
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Country | US
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Telephone | 347-405-8160
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Fax | 347-405-8161
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Authorized Official
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Title or Position | OWNER
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Name | CAROLINE NOVAK
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Credential | MD
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Telephone | 347-405-8160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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