Provider Demographics
NPI:1699233221
Name:IDEAL VASCULAR CENTERS LLC
Entity type:Organization
Organization Name:IDEAL VASCULAR CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HANY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-536-9844
Mailing Address - Street 1:20455 LORAIN RD STE T1
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-3495
Mailing Address - Country:US
Mailing Address - Phone:216-536-9844
Mailing Address - Fax:
Practice Address - Street 1:20455 LORAIN RD STE T1
Practice Address - Street 2:
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-3495
Practice Address - Country:US
Practice Address - Phone:216-536-9844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-02
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty