Provider Demographics
NPI:1477881399
Name:M&M VASCULAR TECHNOLOGIES, LLC
Entity Type:Organization
Organization Name:M&M VASCULAR TECHNOLOGIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:E
Authorized Official - Last Name:MUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-653-9584
Mailing Address - Street 1:PO BOX 857
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41005-0857
Mailing Address - Country:US
Mailing Address - Phone:859-653-9584
Mailing Address - Fax:859-586-7740
Practice Address - Street 1:2510 LEGENDS WAY
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-2370
Practice Address - Country:US
Practice Address - Phone:859-653-9584
Practice Address - Fax:859-586-7740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty