Provider Demographics
NPI:1306917943
Name:VEIN RESTORATION GROUP, INC.
Entity type:Organization
Organization Name:VEIN RESTORATION GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:TESORIERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-964-5347
Mailing Address - Street 1:PO BOX 865028
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75086-5028
Mailing Address - Country:US
Mailing Address - Phone:972-964-5347
Mailing Address - Fax:972-599-1853
Practice Address - Street 1:2828 W PARKER RD
Practice Address - Street 2:SUITE B106F
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-9153
Practice Address - Country:US
Practice Address - Phone:972-964-5347
Practice Address - Fax:972-599-1853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0090PGOtherBCBS
TX0090PGOtherBCBS