Provider Demographics
NPI:1447343090
Name:CHICAGO VEIN INSTITUTE S.C.
Entity type:Organization
Organization Name:CHICAGO VEIN INSTITUTE S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LEJLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SUNJE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:773-989-0562
Mailing Address - Street 1:4906 N. WESTERN AVE.
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625
Mailing Address - Country:US
Mailing Address - Phone:773-989-0562
Mailing Address - Fax:
Practice Address - Street 1:4906 N. WESTERN AVE.
Practice Address - Street 2:SUITE 2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625
Practice Address - Country:US
Practice Address - Phone:773-989-0562
Practice Address - Fax:773-506-7341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036103665202K00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208486Medicare PIN