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
—
—
Other
Enumeration date
03/20/2023
Last updated
03/20/2023
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