Organization
CENTER FOR VEIN RESTORATION MI PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORENA THOMAS (CREDENTIALING MANAGER)
(815) 254-1761
Entity
Organization
Contact information
Practice address
3810 W CENTRE AVE STE A, PORTAGE, MI 49024-4632
(301) 860-0930
Mailing address
7474 GREENWAY CENTER DR STE 1000, GREENBELT, MD 20770-3500
(855) 830-8346
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
D0053733
MD
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
D0053733
MD
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
11/01/2010
Last updated
05/30/2024
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