Provider Demographics
NPI:1588156541
Name:CENTER FOR VEIN RESTORATION IL LLC
Entity type:Organization
Organization Name:CENTER FOR VEIN RESTORATION IL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHANH
Authorized Official - Middle Name:Q
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:855-830-8346
Mailing Address - Street 1:7474 GREENWAY CENTER DR STE 1000
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3500
Mailing Address - Country:US
Mailing Address - Phone:152-541-7618
Mailing Address - Fax:815-254-5431
Practice Address - Street 1:2001 BUTTERFIELD RD STE 1000
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-5476
Practice Address - Country:US
Practice Address - Phone:855-830-8346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-05
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
IL036139055207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty