Provider Demographics
NPI:1427013390
Name:VASCULAR DIAGNOSTICS, LTD
Entity type:Organization
Organization Name:VASCULAR DIAGNOSTICS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-298-7876
Mailing Address - Street 1:1600 DEMPSTER ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1109
Mailing Address - Country:US
Mailing Address - Phone:847-298-7876
Mailing Address - Fax:847-298-7886
Practice Address - Street 1:1600 DEMPSTER ST
Practice Address - Street 2:SUITE 105
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1109
Practice Address - Country:US
Practice Address - Phone:847-298-7876
Practice Address - Fax:847-298-7886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0551070001OtherNATIONAL GOVERNMENT SERVICES
IL694920Medicare ID - Type Unspecified
IL0551070001OtherNATIONAL GOVERNMENT SERVICES