Provider Demographics
NPI:1407484645
Name:MACUMBER MEDICAL LTD
Entity Type:Organization
Organization Name:MACUMBER MEDICAL LTD
Other - Org Name:ADVANCED VEIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MACUMBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-220-0376
Mailing Address - Street 1:3114 W IRVING PARK RD STE 1W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3435
Mailing Address - Country:US
Mailing Address - Phone:833-388-7669
Mailing Address - Fax:833-388-7669
Practice Address - Street 1:3114 W IRVING PARK RD STE 1W
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3435
Practice Address - Country:US
Practice Address - Phone:833-388-7669
Practice Address - Fax:833-388-7669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-01
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty