Provider Demographics
NPI:1649861451
Name:GENERATION VEIN CLINIC LLC
Entity type:Organization
Organization Name:GENERATION VEIN CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:DR
Authorized Official - First Name:YEVGENY
Authorized Official - Middle Name:
Authorized Official - Last Name:BULBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-845-6465
Mailing Address - Street 1:7800 N MILWAUKEE AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-3124
Mailing Address - Country:US
Mailing Address - Phone:224-888-3033
Mailing Address - Fax:
Practice Address - Street 1:7800 N MILWAUKEE AVE STE 105
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-3124
Practice Address - Country:US
Practice Address - Phone:224-888-3033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-03
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty