Provider Demographics
NPI:1972779270
Name:INTERNATIONAL VEIN & SKIN INSTITUTE SC
Entity Type:Organization
Organization Name:INTERNATIONAL VEIN & SKIN INSTITUTE SC
Other - Org Name:JOZEF TRYZNO MD & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOZEF
Authorized Official - Middle Name:
Authorized Official - Last Name:TRYZNO
Authorized Official - Suffix:
Authorized Official - Credentials:MD, RVT
Authorized Official - Phone:847-518-9999
Mailing Address - Street 1:760 BUSSE HWY
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-2402
Mailing Address - Country:US
Mailing Address - Phone:847-518-9999
Mailing Address - Fax:847-518-2288
Practice Address - Street 1:760 BUSSE HWY
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-2402
Practice Address - Country:US
Practice Address - Phone:847-518-9999
Practice Address - Fax:847-518-2288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089963202K00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty