MEDICARE: USA VEIN CLINICS OF ATLANTA

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

General Provider Information

NPI Number	:	1972901627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	USA VEIN CLINICS OF ATLANTA

Provider Business Mailing Address
First Line	:	1230 UPPER HEMBREE RD
Second Line	:	SUITE 202
City	:	ROSWELL
State	:	GA
Zip	:	30076-0911
Country	:	US
Telephone Number	:	847-305-3346
Fax Number	:	224-246-8042

Provider Business Practice Location Address
First Line	:	4141 DUNDEE RD
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-2129
Country	:	US
Telephone Number	:	847-305-3346
Fax Number	:	224-246-8042

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. YAN KATSNELSON
Credential	:	MD
Telephone Number	:	847-305-3346

Provider Enumeration Date	:	12/11/2014
Last Update Date	:	12/11/2014

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