Organization
LONGEVITY CENTERS OF ILLINOIS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YAN KATSNELSON (CEO)
(847) 774-5300
Entity
Organization
Contact information
Practice address
550 N LAKE ST STE 1, MUNDELEIN, IL 60060-1827
(847) 593-8460
Mailing address
PO BOX 451, NORTHBROOK, IL 60065-0451
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Enumeration date
12/16/2022
Last updated
04/16/2024
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