MEDICARE: ADVANCED VEIN TREATMENT AND IMAGING CENTER 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	261QR0200X	Radiology Clinic/Center	036-099445	IL

General Provider Information

NPI Number	:	1285746487
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED VEIN TREATMENT AND IMAGING CENTER LLC

Provider Business Mailing Address
First Line	:	721 W IL ROUTE 22
Second Line	:
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-2552
Country	:	US
Telephone Number	:	708-827-5732
Fax Number	:	708-827-5742

Provider Business Practice Location Address
First Line	:	721 W STATE ROUTE 22
Second Line	:
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-2552
Country	:	US
Telephone Number	:	708-827-5732
Fax Number	:	708-827-5742

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. AMJAD ALI SAFVI
Credential	:	MD
Telephone Number	:	708-827-5732

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	07/08/2024

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