Organization
PREMIER VASCULAR, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK BERLIN (COO)
(708) 478-3600
Entity
Organization
Contact information
Practice address
11560 S KEDZIE AVE, MERRIONETTE PARK, IL 60803-4517
(708) 478-3600
(708) 478-3553
Mailing address
11560 S KEDZIE AVE, MERRIONETTE PARK, IL 60803-4517
(708) 972-7525
(708) 972-7526
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
—
—
207RC0001X
Clinical Cardiac Electrophysiology Physician
—
—
207RI0011X
Interventional Cardiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F100329328
MEDICARE PTAN
IL
Enumeration date
05/26/2016
Last updated
10/25/2016
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