# VASCULAR SURGERY & NONINVASIVE DIAGNOSTICS LLC

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

## Provider details

- **NPI number:** 1386716256
- **Authorized official:** DR. JOSEPH DURHAM M.D. (PRESIDENT)
- **Authorized official phone:** (773) 206-7197

## Contact information

- **Practice address:** 1 INGALLS DRIVE, LL-NORTH BLDG, HARVEY, IL 60426
- **Practice address phone:** (708) 915-4588
- **Mailing address:** 10347 S LONGWOOD DR, CHICAGO, IL 60643-2610
- **Mailing address phone:** (773) 206-7197

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | — | IL | Yes |

## Other

- **Enumeration date:** 11/15/2006
- **Last updated:** 07/21/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 01628302 | BLUE CROSS BLUE SHIELD | IL |