Organization
VASCULAR SURGERY ASSOCIATES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTIN IRA ELLENBY MD (MANAGER)
(708) 346-9533
Entity
Organization
Contact information
Practice address
10258 SOUTHWEST HWY STE A, CHICAGO RIDGE, IL 60415-1361
(708) 346-9533
(708) 499-4312
Mailing address
10258 SOUTHWEST HWY STE A, CHICAGO RIDGE, IL 60415-1361
(708) 346-9533
(708) 499-4312
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0001538791793
—
IL
Enumeration date
02/06/2020
Last updated
03/27/2020
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