Provider Demographics
NPI:1689608846
Name:FLORIDA PHLEBOLOGY INC
Entity Type:Organization
Organization Name:FLORIDA PHLEBOLOGY INC
Other - Org Name:VEIN CLINICS OF AMERICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-725-2768
Mailing Address - Street 1:1901 BUTTERFIELD RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-7915
Mailing Address - Country:US
Mailing Address - Phone:630-725-2730
Mailing Address - Fax:
Practice Address - Street 1:2000 PALM BEACH LAKES BLVD
Practice Address - Street 2:SUITE 734
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6503
Practice Address - Country:US
Practice Address - Phone:561-471-4050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL202K00000X, 2085R0204X, 208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9272Medicare PIN