Provider Demographics
NPI:1386716256
Name:VASCULAR SURGERY & NONINVASIVE DIAGNOSTICS LLC
Entity type:Organization
Organization Name:VASCULAR SURGERY & NONINVASIVE DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-206-7197
Mailing Address - Street 1:10347 S LONGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-2610
Mailing Address - Country:US
Mailing Address - Phone:773-206-7197
Mailing Address - Fax:
Practice Address - Street 1:1 INGALLS DRIVE, LL-NORTH BLDG
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426
Practice Address - Country:US
Practice Address - Phone:708-915-4588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01628302OtherBLUE CROSS BLUE SHIELD
IL01628302OtherBLUE CROSS BLUE SHIELD
ILCJ9139OtherPALMETTO RR MEDICARE