# VALLEY VILLAGE VEIN CLINIC PC

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

## Provider details

- **NPI number:** 1811201643
- **Authorized official:** DR. FLORA KATSNELSON MD (OWNER)
- **Authorized official phone:** (847) 593-8616

## Contact information

- **Practice address:** 12840 RIVERSIDE DR, STE 300, VALLEY VILLAGE, CA 91607-3327
- **Practice address phone:** (847) 593-8616
- **Practice address fax:** (888) 398-3230
- **Mailing address:** PO BOX 832, NORTHBROOK, IL 60065-0832
- **Mailing address phone:** (262) 877-8752
- **Mailing address fax:** (888) 398-3230

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/04/2010
- **Last updated:** 09/13/2012