Provider Demographics
NPI:1497479331
Name:CHARMING SKIN VEIN CENTER LLC
Entity Type:Organization
Organization Name:CHARMING SKIN VEIN CENTER LLC
Other - Org Name:CHARMING SKIN VEIN CENTER LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAWDAT
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-966-4820
Mailing Address - Street 1:5907 W 63RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-5409
Mailing Address - Country:US
Mailing Address - Phone:708-966-4820
Mailing Address - Fax:888-460-3322
Practice Address - Street 1:5907 W 63RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-5409
Practice Address - Country:US
Practice Address - Phone:708-966-4820
Practice Address - Fax:888-460-3322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-03
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty