Basic Information
| Provider Information | |||||||||
| NPI: | 1437700531 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAIRFIELD INTERVENTIONAL AND VASCULAR SPECIALISTS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 BUTTERFIELD RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | DOWNERS GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605151069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307252700 | ||||||||
| FaxNumber: | 8338425469 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 SASCO HILL RD STE 2 | ||||||||
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| City: | FAIRFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068245670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032560070 | ||||||||
| FaxNumber: | 2032560077 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2019 | ||||||||
| LastUpdateDate: | 09/20/2019 | ||||||||
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| AuthorizedOfficialLastName: | ESPARZA | ||||||||
| AuthorizedOfficialFirstName: | LORENZ | ||||||||
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| AuthorizedOfficialTitleorPosition: | REVENUE CYCLE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6307252764 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.