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Organization
VASCULAR SURGERY & NONINVASIVE DIAGNOSTICS LLC
Active
Organization
VASCULAR SURGERY & NONINVASIVE DIAGNOSTICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH DURHAM M.D. (PRESIDENT)
(773) 206-7197
Entity
Organization
Contact information
Practice address
1 INGALLS DRIVE, LL-NORTH BLDG, HARVEY, IL 60426
(708) 915-4588
Mailing address
10347 S LONGWOOD DR, CHICAGO, IL 60643-2610
(773) 206-7197
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01628302
BLUE CROSS BLUE SHIELD
IL
Enumeration date
11/15/2006
Last updated
07/21/2022
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