Organization
INDIANA PHLEBOLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NATHAN AMORUSO (SR VP REVENUE)
(847) 593-8460
Entity
Organization
Contact information
Practice address
371 E 84TH DR STE 371, MERRILLVILLE, IN 46410-6484
(219) 736-7165
Mailing address
PO BOX 451, NORTHBROOK, IL 60065-0451
(847) 593-8460
(877) 285-5883
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
—
IN
2085R0204X
Vascular & Interventional Radiology Physician
—
IN
208600000X
Surgery Physician
Primary
—
IN
2086S0129X
Vascular Surgery Physician
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DO6229
MEDICARE RAILROAD
IN
Enumeration date
09/16/2006
Last updated
05/04/2023
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