Provider Demographics
NPI:1285062935
Name:VEIN SPECIALISTS
Entity type:Organization
Organization Name:VEIN SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:MAGNAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-694-8346
Mailing Address - Street 1:1510 ROYAL PALM SQUARE BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-1068
Mailing Address - Country:US
Mailing Address - Phone:239-694-8346
Mailing Address - Fax:239-936-6272
Practice Address - Street 1:3359 WOODS EDGE CIR
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-3327
Practice Address - Country:US
Practice Address - Phone:239-694-8346
Practice Address - Fax:239-936-6272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME949042086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE67570Medicare UPIN
FLU8207YMedicare PIN