Basic Information
| Provider Information | |||||||||
| NPI: | 1538692876 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHICAGO VASCULAR ASC LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 VALLEY STREAM PKWY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MALVERN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193551407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106448900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 700 PASQUINELLI DR | ||||||||
| Address2: | |||||||||
| City: | WESTMONT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605591382 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6303238690 | ||||||||
| FaxNumber: | 6303238657 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2017 | ||||||||
| LastUpdateDate: | 07/03/2017 | ||||||||
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| AuthorizedOfficialLastName: | MAKRIS | ||||||||
| AuthorizedOfficialFirstName: | ANGELO | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 6303238690 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.