Provider Demographics
NPI:1346592524
Name:VEIN INSTITUTE OF ARIZONA LLC
Entity Type:Organization
Organization Name:VEIN INSTITUTE OF ARIZONA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANUPAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AHLAWAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-294-4494
Mailing Address - Street 1:1343 NORTH ALMA SCHOOL ROAD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5901
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:480-726-0695
Practice Address - Street 1:1343 NORTH ALMA SCHOOL ROAD
Practice Address - Street 2:SUITE 160
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5901
Practice Address - Country:US
Practice Address - Phone:480-444-7447
Practice Address - Fax:480-726-0695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-11
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ750046Medicaid