Provider Demographics
NPI:1376845289
Name:ILLINOIS VEIN SPECIALISTS-ELGIN SC
Entity Type:Organization
Organization Name:ILLINOIS VEIN SPECIALISTS-ELGIN SC
Other - Org Name:VEIN SPECIALISTS OF ILLINOIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SORENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-468-9900
Mailing Address - Street 1:1670 CAPITAL ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60124-7837
Mailing Address - Country:US
Mailing Address - Phone:847-468-9900
Mailing Address - Fax:847-468-9901
Practice Address - Street 1:1670 CAPITAL ST
Practice Address - Street 2:SUITE 500
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60124-7837
Practice Address - Country:US
Practice Address - Phone:847-468-9900
Practice Address - Fax:847-468-9901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-29
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-092571174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty