Provider Demographics
NPI:1760715262
Name:SCOTTSDALE VEIN CENTER PLLC
Entity Type:Organization
Organization Name:SCOTTSDALE VEIN CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:W
Authorized Official - Last Name:LUNDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-483-0208
Mailing Address - Street 1:8600 E VIA DE VENTURA STE 103
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-3324
Mailing Address - Country:US
Mailing Address - Phone:480-483-0208
Mailing Address - Fax:480-905-8346
Practice Address - Street 1:8600 E VIA DE VENTURA STE 103
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3324
Practice Address - Country:US
Practice Address - Phone:480-483-0208
Practice Address - Fax:480-905-8346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14274174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty