Provider Demographics
NPI:1689224719
Name:ILLINOIS UVC MEDICAL PLLC
Entity Type:Organization
Organization Name:ILLINOIS UVC MEDICAL PLLC
Other - Org Name:UNITED VEIN & VASCULAR CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ADMINISTRATION OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:WAZNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-991-6117
Mailing Address - Street 1:3810 NORTHDALE BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1871
Mailing Address - Country:US
Mailing Address - Phone:813-961-1331
Mailing Address - Fax:888-850-8316
Practice Address - Street 1:4700 W 95TH ST STE 303
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2572
Practice Address - Country:US
Practice Address - Phone:800-991-6117
Practice Address - Fax:888-812-8191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-20
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty