Provider Demographics
NPI:1174762744
Name:CHICAGO VEIN & LASER INSTITUTE S.C.
Entity type:Organization
Organization Name:CHICAGO VEIN & LASER INSTITUTE S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PARAG
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-312-1301
Mailing Address - Street 1:915 CENTER ST
Mailing Address - Street 2:SUITE 2002
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-2106
Mailing Address - Country:US
Mailing Address - Phone:847-312-1301
Mailing Address - Fax:847-844-8205
Practice Address - Street 1:915 CENTER ST
Practice Address - Street 2:SUITE 2002
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-2106
Practice Address - Country:US
Practice Address - Phone:847-312-1301
Practice Address - Fax:847-844-8205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-086709207RI0011X, 207UN0901X
IL036086709207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty