# INNOVATIVE VASCULAR AND THERAPEUTICS, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386291664
- **Authorized official:** DR. MALWINDER SINGH SINGHA MD (PRESIDENT)
- **Authorized official phone:** (401) 575-0308

## Contact information

- **Practice address:** 1515 N HARLEM AVE STE 100, OAK PARK, IL 60302-1205
- **Practice address phone:** (401) 575-0308
- **Practice address fax:** (562) 548-7540
- **Mailing address:** PO BOX 379, PASADENA, CA 91102-0379
- **Mailing address phone:** (401) 575-0308
- **Mailing address fax:** (562) 548-7540

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085R0202X | Diagnostic Radiology Physician | — | NULL | — |
| 2085R0202X | Diagnostic Radiology Physician | — | — | — |
| 2085R0204X | Vascular & Interventional Radiology Physician | — | NULL | Yes |
| 2085R0204X | Vascular & Interventional Radiology Physician | — | — | Yes |
| 2086S0129X | Vascular Surgery Physician | — | NULL | — |
| 2086S0129X | Vascular Surgery Physician | — | — | — |
| 367500000X | Certified Registered Nurse Anesthetist | — | NULL | — |
| 367500000X | Certified Registered Nurse Anesthetist | — | — | — |

## Other

- **Enumeration date:** 08/21/2019
- **Last updated:** 05/08/2023