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General NPI Number Information
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NPI Number | 1841654423
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Entity Type | Organization
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Legal Business Name | NELLESTEIN VEIN INSTITUTE LLC
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Dates
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Enumeration Date | 04/08/2016
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Last Update Date | 01/17/2017
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Provider Practice Location Address
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Address Line | 1341 VILLAGE DR
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City | SAINT JOSEPH
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State | MO
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Zip | 64506-2457
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Country | US
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Telephone | 816-291-4149
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Fax | 816-897-3969
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Provider Business Mailing Address
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Address Line | 1341 VILLAGE DR
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City | SAINT JOSEPH
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State | MO
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Zip | 64506-2457
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Country | US
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Telephone | 816-291-4149
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Fax | 816-897-3969
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MICHAEL E. NELLESTEIN
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Credential | MD
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Telephone | 816-291-4149
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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 | MO
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State | MO
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