=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538692876
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHICAGO VASCULAR ASC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2017
-----------------------------------------------------
Last Update Date | 08/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 PASQUINELLI DR
-----------------------------------------------------
City | WESTMONT
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60559-1382
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-323-8690
-----------------------------------------------------
Fax | 630-323-8657
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 419721
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02241-9721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-644-8900
-----------------------------------------------------
Fax | 484-924-0053
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | DR. ANGELO MAKRIS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 630-323-8690
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------