Provider Demographics
NPI:1629813787
Name:NANI VASCULAR NORTH ASC LLC
Entity type:Organization
Organization Name:NANI VASCULAR NORTH ASC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'DEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-974-5225
Mailing Address - Street 1:120 W 22ND STREET
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60523
Mailing Address - Country:US
Mailing Address - Phone:630-573-5000
Mailing Address - Fax:630-368-0280
Practice Address - Street 1:2055 W ARMY TRAIL RD STE 110
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-1478
Practice Address - Country:US
Practice Address - Phone:630-573-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-28
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty