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General NPI Number Information
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NPI Number | 1467253070
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Entity Type | Organization
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Legal Business Name | VAX CONCIERGE OH LLC
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Dates
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Enumeration Date | 03/20/2025
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 6 LOUIS DR
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City | PEPPER PIKE
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State | OH
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Zip | 44124-4313
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Country | US
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Telephone | 773-260-0964
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Fax |
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Provider Business Mailing Address
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Address Line | 7257 N LINCOLN AVE
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City | LINCOLNWOOD
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State | IL
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Zip | 60712-1810
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Country | US
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Telephone | 773-260-0964
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Fax |
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Authorized Official
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Title or Position | MD/OWNER
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Name | BENJAMIN GARDEN
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Credential | MD
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Telephone | 773-451-6215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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