| Grand Vein Specialists LLC | |
|
4952 W Irving Park Rd Ste 300 Chicago IL 60641-2693 | |
| (773) 942-6141 | |
| (866) 707-2267 |
| Full Name | Grand Vein Specialists LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 4952 W Irving Park Rd Ste 300, Chicago, Illinois |
| Authorized Official Name and Position | Javier Flores (OWNER) |
| Authorized Official Contact | 7739426141 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grand Vein Specialists LLC 4952 W Irving Park Rd Ste 300 Chicago IL 60641-2693 Ph: (773) 942-6141 | Grand Vein Specialists LLC 4952 W Irving Park Rd Ste 300 Chicago IL 60641-2693 Ph: (773) 942-6141 |
| NPI Number | 1255603247 |
|---|---|
| Provider Enumeration Date | 02/06/2012 |
| Last Update Date | 02/09/2021 |
| Certification Date | 02/09/2021 |
| Medicare PECOS PAC ID | 9739343203 |
|---|---|
| Medicare Enrollment ID | O20120619000523 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255603247 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036-116087 (Illinois) | Primary |
| 202K00000X | Phlebology | 036-116087 (Illinois) | Secondary |
| Provider Name | Javier Flores |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164445854 PECOS PAC ID: 7517964414 Enrollment ID: I20061108000108 |
| Provider Name | Victor Munoz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992962146 PECOS PAC ID: 1951469634 Enrollment ID: I20081024000184 |
| Provider Name | Juanita Mora |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1750557179 PECOS PAC ID: 1850562794 Enrollment ID: I20110926000244 |
| Provider Name | Libin Manuel Zevallos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649637976 PECOS PAC ID: 6204242191 Enrollment ID: I20210301000848 |
| Provider Name | Alicia Estrada |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003510751 PECOS PAC ID: 2062877137 Enrollment ID: I20230424002362 |
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