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General NPI Number Information
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NPI Number | 1841547098
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Entity Type | Organization
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Legal Business Name | NORTH SHORE VEIN CLINICS LLC
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Dates
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Enumeration Date | 08/07/2012
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Last Update Date | 05/24/2022
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Provider Practice Location Address
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Address Line | 4141 DUNDEE RD
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City | NORTHBROOK
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State | IL
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Zip | 60062
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Country | US
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Telephone | 847-897-6868
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Fax | 888-621-3330
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Provider Business Mailing Address
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Address Line | PO BOX 451
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City | NORTHBROOK
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State | IL
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Zip | 60065-0451
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Country | US
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Telephone | 847-897-6868
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Fax | 888-621-3330
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Authorized Official
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Title or Position | MANAGER
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Name | DR. YAN KATSNELSON
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Credential | MD
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Telephone | 847-897-6868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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