Provider Demographics
NPI:1487196424
Name:AMERICAN VEIN INSTITUTE LLC
Entity Type:Organization
Organization Name:AMERICAN VEIN INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-418-2427
Mailing Address - Street 1:10020 DUPONT CIRCLE CT STE 140
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1621
Mailing Address - Country:US
Mailing Address - Phone:260-418-2427
Mailing Address - Fax:260-489-4188
Practice Address - Street 1:10020 DUPONT CIRCLE CT STE 140
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1621
Practice Address - Country:US
Practice Address - Phone:260-418-2427
Practice Address - Fax:260-489-4188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty