Provider Demographics
NPI:1619412574
Name:INSTITUTE FOR VEIN HEALTH LLC
Entity Type:Organization
Organization Name:INSTITUTE FOR VEIN HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUKASZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-401-7102
Mailing Address - Street 1:1450 W LAKE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-5768
Mailing Address - Country:US
Mailing Address - Phone:630-401-7102
Mailing Address - Fax:630-566-6879
Practice Address - Street 1:1450 W LAKE ST STE 101
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-5768
Practice Address - Country:US
Practice Address - Phone:630-401-7102
Practice Address - Fax:630-566-6879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-03
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036111722202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Single Specialty