Provider Demographics
NPI:1760011308
Name:THE VEIN CLINIC OF DALLAS LLC
Entity Type:Organization
Organization Name:THE VEIN CLINIC OF DALLAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HUSEIN
Authorized Official - Middle Name:
Authorized Official - Last Name:POONAWALA
Authorized Official - Suffix:
Authorized Official - Credentials:M
Authorized Official - Phone:818-825-3038
Mailing Address - Street 1:3051 CHURCHILL DR STE 116
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-5900
Mailing Address - Country:US
Mailing Address - Phone:469-846-8346
Mailing Address - Fax:
Practice Address - Street 1:3051 CHURCHILL DR STE 116
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-5900
Practice Address - Country:US
Practice Address - Phone:698-468-3464
Practice Address - Fax:469-409-0001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-06
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty