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General NPI Number Information
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NPI Number | 1982119319
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Entity Type | Organization
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Legal Business Name | VEIN AND VASCULAR CENTERS, SC
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Dates
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Enumeration Date | 12/07/2017
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Last Update Date | 12/20/2017
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Provider Practice Location Address
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Address Line | 7 N GRANT ST STE 1
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City | HINSDALE
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State | IL
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Zip | 60521-3366
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Country | US
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Telephone | 630-320-6877
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Fax |
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Provider Business Mailing Address
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Address Line | 903 COMMERCE DR STE 333
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City | OAK BROOK
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State | IL
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Zip | 60523-8723
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Country | US
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Telephone | 630-928-5234
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING CONSULTANT
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Name | DIANE SARKA
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Credential |
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Telephone | 630-928-5234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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