Provider Demographics
NPI:1265758569
Name:VARICOSE SOLUTIONS LLC
Entity type:Organization
Organization Name:VARICOSE SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:FERNANDO
Authorized Official - Last Name:ZAPATA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-628-7413
Mailing Address - Street 1:4959 W BELMONT AVE
Mailing Address - Street 2:SUITE S
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-4332
Mailing Address - Country:US
Mailing Address - Phone:773-628-7413
Mailing Address - Fax:773-628-7582
Practice Address - Street 1:4959 W BELMONT AVE
Practice Address - Street 2:SUITE S
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-4332
Practice Address - Country:US
Practice Address - Phone:773-628-7413
Practice Address - Fax:773-628-7582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-12
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036110036207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1601328OtherBCBS OF IL
ILIL3839Medicare PIN