Provider Demographics
NPI:1497361943
Name:ADVANCED ENDOVASCULAR INSTITUTE
Entity Type:Organization
Organization Name:ADVANCED ENDOVASCULAR INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IMRAAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANSAARIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-232-9203
Mailing Address - Street 1:209 PINEHURST POINTE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3703
Mailing Address - Country:US
Mailing Address - Phone:386-232-9203
Mailing Address - Fax:386-222-3064
Practice Address - Street 1:1301 PLANTATION ISLAND DR S STE 401A
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-3118
Practice Address - Country:US
Practice Address - Phone:386-232-9203
Practice Address - Fax:386-222-3064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-21
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty