Congress Vein Clinic LLC
Organization Active NPI Trauma Surgery Physician · Chicago, IL
NPI 1467986901 · NPPES record last updated Apr 11, 2017
Key facts
- NPI
- 1467986901
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Trauma Surgery Physician 2086S0127X
- Legal business name
- CONGRESS VEIN CLINIC LLC
- Practice address
- 41 W Congress Pkwy
1St Floor
Chicago, IL 60605-1531 - Phone
- (847) 593-8460
- Fax
- (224) 246-8042
- NPI assigned
- Apr 11, 2017
- Organization subpart
- No
Authorized official
- Name
- Yan Katsnelson, MD
- Title
- Ceo
- Phone
- (847) 257-1244
Practitioners 15
-
Yan Katsnelson, M.D.
-
Kevin M Smith, MD
-
Di Fan, M.D.
-
Charles Perrott, MD
-
Binita Chandran, MD
-
Carlos E Feliciano, M.D.
-
Aaron Opher Shiloh, M.D.
-
Benjamin B Tang, M.D.
-
Jacob White, MD
-
Phillip Leon Cacioppo, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180316001093 | IL | Part B Supplier - Clinic/Group Practice | 6709148414 |
Receives reassigned benefits from 14 practitioners Practice locations: Chicago, IL |
National Provider Directory
Locations
41 W Ida B Wells Dr
Ste B
Chicago, IL 60605
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Trauma Surgery Physician |
2086S0127X | Yes |
Addresses
Primary practice location
41 W Congress Pkwy
1St Floor
Chicago, IL 60605-1531
Mailing address
304 Wainwright Dr
Northbrook, IL 60062-1900
Phone (847) 257-1244
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All providers in Chicago, IL · Trauma Surgery Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 11, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.