Provider Demographics
NPI:1194910349
Name:CHICAGO VEIN INSTITUTE S.C.
Entity type:Organization
Organization Name:CHICAGO VEIN INSTITUTE S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MENSUR
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNJE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-506-7340
Mailing Address - Street 1:10004 KENNERLY RD # 335
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2141
Mailing Address - Country:US
Mailing Address - Phone:773-506-7340
Mailing Address - Fax:773-506-7341
Practice Address - Street 1:10004 KENNERLY RD # 335
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2141
Practice Address - Country:US
Practice Address - Phone:773-506-7340
Practice Address - Fax:773-506-7341
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHICAGO VEIN INSTITUTE S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-11
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty