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General NPI Number Information
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NPI Number | 1497081863
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Entity Type | Organization
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Legal Business Name | UNITED VASCULAR SC
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Dates
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Enumeration Date | 10/20/2009
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Last Update Date | 12/19/2025
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Provider Practice Location Address
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Address Line | 9730 S WESTERN AVE STE B
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City | EVERGREEN PARK
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State | IL
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Zip | 60805-2814
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Country | US
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Telephone | 888-402-0202
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Fax | 888-860-2960
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Provider Business Mailing Address
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Address Line | PO BOX 7412452
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City | CHICAGO
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State | IL
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Zip | 60674-2452
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Country | US
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Telephone | 248-607-0037
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Fax | 734-462-0344
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Authorized Official
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Title or Position | DIRECTOR OF RCM
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Name | KIMBERLY MILLER
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Credential |
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Telephone | 248-331-7908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 042.619557
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License Number State | IL
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