Basic Information
Provider Information
NPI: 1720228273
EntityType: 2
ReplacementNPI:  
OrganizationName: USA VEIN CLINIC INC
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Mailing Information
Address1: PO BOX 832
Address2:  
City: NORTHBROOK
State: IL
PostalCode: 600650832
CountryCode: US
TelephoneNumber: 8887683467
FaxNumber: 2628772632
Practice Location
Address1: 7901 SANTA MONICA BLVD
Address2: SUITE 209
City: WEST HOLLYWOOD
State: CA
PostalCode: 900465177
CountryCode: US
TelephoneNumber: 8887683467
FaxNumber: 2628772632
Other Information
ProviderEnumerationDate: 02/24/2009
LastUpdateDate: 05/27/2011
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AuthorizedOfficialLastName: KATSNELSON
AuthorizedOfficialFirstName: FLORA
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AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 2628778752
IsSoleProprietor:  
IsOrganizationSubpart: N
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AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2086S0129XA106254CAY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery

ID Information
IDTypeStateIssuerDescription
A10625401CAMEDICAL LICENSEOTHER


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