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General NPI Number Information
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NPI Number | 1699233221
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Entity Type | Organization
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Legal Business Name | IDEAL VASCULAR CENTERS LLC
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Dates
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Enumeration Date | 03/02/2019
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Last Update Date | 04/09/2019
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Provider Practice Location Address
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Address Line | 20455 LORAIN RD STE T1
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City | FAIRVIEW PARK
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State | OH
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Zip | 44126-3495
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Country | US
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Telephone | 216-536-9844
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Fax |
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Provider Business Mailing Address
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Address Line | 20455 LORAIN RD STE T1
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City | FAIRVIEW PARK
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State | OH
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Zip | 44126-3495
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Country | US
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Telephone | 216-536-9844
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HANY ANTON
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Credential | MD
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Telephone | 216-536-9844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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