Provider Demographics
NPI:1073980983
Name:ADVANCED VASCULAR INSTITUTE & CANCER CARE
Entity Type:Organization
Organization Name:ADVANCED VASCULAR INSTITUTE & CANCER CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUDHEER
Authorized Official - Middle Name:
Authorized Official - Last Name:PARUCHURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-622-7622
Mailing Address - Street 1:900 OAKMONT LN
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5530
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1515 N HARLEM AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1250
Practice Address - Country:US
Practice Address - Phone:312-473-4748
Practice Address - Fax:312-924-5924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-26
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty