Provider Demographics
NPI:1770024721
Name:CROWN POINT VEIN CLINIC LLC
Entity Type:Organization
Organization Name:CROWN POINT VEIN CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-257-1244
Mailing Address - Street 1:333 W 89TH AVE
Mailing Address - Street 2:W2
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7073
Mailing Address - Country:US
Mailing Address - Phone:219-769-8346
Mailing Address - Fax:224-246-8042
Practice Address - Street 1:304 WAINWRIGHT DR
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1900
Practice Address - Country:US
Practice Address - Phone:847-257-1244
Practice Address - Fax:224-246-8042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty