Provider Demographics
NPI:1982119319
Name:VEIN AND VASCULAR CENTERS, SC
Entity Type:Organization
Organization Name:VEIN AND VASCULAR CENTERS, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:SARKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-928-5234
Mailing Address - Street 1:903 COMMERCE DR STE 333
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8723
Mailing Address - Country:US
Mailing Address - Phone:630-928-5234
Mailing Address - Fax:
Practice Address - Street 1:7 N GRANT ST STE 1
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3366
Practice Address - Country:US
Practice Address - Phone:630-320-6877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-07
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036096152OtherSTATE LICENSE