Provider Demographics
NPI:1992126668
Name:VASCULAR SPECIALISTS LLC
Entity type:Organization
Organization Name:VASCULAR SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:TANQUILUT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:708-305-0248
Mailing Address - Street 1:20060 GOVERNORS DR STE 102
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1099
Mailing Address - Country:US
Mailing Address - Phone:815-824-4406
Mailing Address - Fax:708-856-0567
Practice Address - Street 1:20060 GOVERNORS DR STE 102
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1099
Practice Address - Country:US
Practice Address - Phone:708-305-2620
Practice Address - Fax:708-856-0567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-26
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty