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Organization
THIRD COAST VASCULAR ASC LLC
Active
Organization
THIRD COAST VASCULAR ASC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAHA SIDERS MD (CHIEF OPERATING OFFICER)
(262) 577-0250
Entity
Organization
Contact information
Practice address
1441 N TAYLOR DR, SHEBOYGAN, WI 53081-1989
(262) 577-0250
(262) 577-0251
Mailing address
2500 W LAYTON AVE STE 40, MILWAUKEE, WI 53221-5420
(262) 577-0250
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
NULL
Other
Enumeration date
03/20/2023
Last updated
03/20/2023
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