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General NPI Number Information
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NPI Number | 1588156541
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Entity Type | Organization
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Legal Business Name | CENTER FOR VEIN RESTORATION IL LLC
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Dates
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Enumeration Date | 06/05/2018
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Last Update Date | 04/30/2024
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Provider Practice Location Address
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Address Line | 2001 BUTTERFIELD RD STE 1000
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-5476
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Country | US
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Telephone | 855-830-8346
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Fax |
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Provider Business Mailing Address
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Address Line | 7474 GREENWAY CENTER DR STE 1000
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City | GREENBELT
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State | MD
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Zip | 20770-3500
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Country | US
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Telephone | 152-541-7618
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Fax | 815-254-5431
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Authorized Official
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Title or Position | OWNER
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Name | DR. KHANH Q. NGUYEN
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Credential | DO
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Telephone | 855-830-8346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036139055
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License Number State | IL
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