MEDICARE: USA VEIN CLINIC INC

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	A106254	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A106254	OTHER	CA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1720228273
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	USA VEIN CLINIC INC

Provider Business Mailing Address
First Line	:	PO BOX 832
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60065-0832
Country	:	US
Telephone Number	:	888-768-3467
Fax Number	:	262-877-2632

Provider Business Practice Location Address
First Line	:	7901 SANTA MONICA BLVD
Second Line	:	SUITE 209
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5177
Country	:	US
Telephone Number	:	888-768-3467
Fax Number	:	262-877-2632

Authorized Official
Title or Position	:	OWNER
Name	:	FLORA KATSNELSON
Credential	:	MD
Telephone Number	:	262-877-8752

Provider Enumeration Date	:	02/24/2009
Last Update Date	:	05/27/2011

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Directions to “USA VEIN CLINIC INC ” Practice Location

Language	Start Address	Practice Location

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