Provider Demographics
NPI:1841915527
Name:VASCULAR SPECIALISTS OF INDIANA LLC
Entity type:Organization
Organization Name:VASCULAR SPECIALISTS OF INDIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:TANQUILUT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:708-305-0248
Mailing Address - Street 1:8505 183RD ST STE A
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-9354
Mailing Address - Country:US
Mailing Address - Phone:815-824-4406
Mailing Address - Fax:
Practice Address - Street 1:1928 45TH ST
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3917
Practice Address - Country:US
Practice Address - Phone:815-824-4406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty