Provider Demographics
NPI:1285812529
Name:VEIN CARE INSTITUTE, LLC
Entity type:Organization
Organization Name:VEIN CARE INSTITUTE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:TANQUILUT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:708-305-0248
Mailing Address - Street 1:16406 PEPPERWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:ORLAND HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60487-5644
Mailing Address - Country:US
Mailing Address - Phone:708-305-2620
Mailing Address - Fax:
Practice Address - Street 1:3736 W 26TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-3826
Practice Address - Country:US
Practice Address - Phone:773-277-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center