MEDICARE: USA VASCULAR CENTERS OF CHICAGO, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician
2	2086S0129X	Vascular Surgery Physician

General Provider Information

NPI Number	:	1174995674
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	USA VASCULAR CENTERS OF CHICAGO, LLC

Provider Business Mailing Address
First Line	:	4141 DUNDEE RD
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-2129
Country	:	US
Telephone Number	:	847-593-8460
Fax Number	:	224-246-8460

Provider Business Practice Location Address
First Line	:	4141 DUNDEE RD
Second Line	:	SUITE B
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-2129
Country	:	US
Telephone Number	:	847-593-8460
Fax Number	:	224-246-8460

Authorized Official
Title or Position	:	DIRECTOR
Name	:	YAN KATSNELSON
Credential	:	MD
Telephone Number	:	847-593-8460

Provider Enumeration Date	:	10/22/2015
Last Update Date	:	10/22/2015

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