MEDICARE: FLORIDA PHLEBOLOGY INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	202K00000X	Phlebology Physician	FL
2	2086S0129X	Vascular Surgery Physician	FL
3	2085R0204X	Vascular & Interventional Radiology Physician	FL
4	208600000X	Surgery Physician	FL

General Provider Information

NPI Number	:	1689608846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA PHLEBOLOGY INC

Provider Business Mailing Address
First Line	:	1901 BUTTERFIELD RD
Second Line	:	SUITE 220
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-7915
Country	:	US
Telephone Number	:	630-725-2730
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 PALM BEACH LAKES BLVD
Second Line	:	SUITE 734
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6503
Country	:	US
Telephone Number	:	561-471-4050
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAN DOMAN
Credential	:
Telephone Number	:	630-725-2768

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	03/07/2012

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Directions to “FLORIDA PHLEBOLOGY INC ” Practice Location

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