Provider Demographics
NPI:1487133278
Name:USA VASCULAR CENTER OF DECATUR LLC
Entity type:Organization
Organization Name:USA VASCULAR CENTER OF DECATUR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KATSNELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:224-318-0118
Mailing Address - Street 1:PO BOX 1602
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60065-1602
Mailing Address - Country:US
Mailing Address - Phone:847-593-8460
Mailing Address - Fax:224-235-4652
Practice Address - Street 1:495 WINN WAY STE 230
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1736
Practice Address - Country:US
Practice Address - Phone:847-593-8460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty