MEDICARE: USA VEIN CLINICS OF MIAMI, 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	2086S0129X	Vascular Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528734969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	USA VEIN CLINICS OF MIAMI, LLC

Provider Business Mailing Address
First Line	:	PO BOX 971
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60065-0971
Country	:	US
Telephone Number	:	847-593-8460
Fax Number	:

Provider Business Practice Location Address
First Line	:	13241 BARTRAM PARK BLVD UNIT 801
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-5216
Country	:	US
Telephone Number	:	904-595-3626
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	YAN KATSNELSON
Credential	:	M.D.
Telephone Number	:	847-593-8460

Provider Enumeration Date	:	08/17/2021
Last Update Date	:	08/17/2021

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