Provider Demographics
NPI:1205208352
Name:VASCULAR INSTITUTE OF CHATTANOOGA, PLLC
Entity Type:Organization
Organization Name:VASCULAR INSTITUTE OF CHATTANOOGA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:LESAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-602-2750
Mailing Address - Street 1:2358 LIFESTYLE WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2291
Mailing Address - Country:US
Mailing Address - Phone:423-362-6375
Mailing Address - Fax:
Practice Address - Street 1:2358 LIFESTYLE WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2291
Practice Address - Country:US
Practice Address - Phone:423-602-2750
Practice Address - Fax:423-602-2762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD373542085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3883166Medicaid
TN3883166Medicaid