Provider Demographics
NPI:1538391792
Name:USA VEIN CLINICS OF CHICAGO LLC
Entity type:Organization
Organization Name:USA VEIN CLINICS OF CHICAGO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KATSNELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-593-8616
Mailing Address - Street 1:PO BOX 451
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60065-0451
Mailing Address - Country:US
Mailing Address - Phone:847-593-8460
Mailing Address - Fax:
Practice Address - Street 1:4141 DUNDEE RD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2129
Practice Address - Country:US
Practice Address - Phone:847-593-8460
Practice Address - Fax:847-593-8604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361051042086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty