| Modern Vascular Of Glendale, Llc | |
|
11851 N 51st Ave Building G Glendale AZ 85304 | |
| (818) 949-2634 | |
| Not Available |
| Full Name | Modern Vascular Of Glendale, Llc |
|---|---|
| Speciality | Radiology |
| Location | 11851 N 51st Ave, Glendale, Arizona |
| Authorized Official Name and Position | Yury Gampel (MANAGER) |
| Authorized Official Contact | 8188808605 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Modern Vascular Of Glendale, Llc 26500 Agoura Rd Ste 102-587 Calabasas CA 91302-1952 Ph: (818) 880-8605 | Modern Vascular Of Glendale, Llc 11851 N 51st Ave Building G Glendale AZ 85304 Ph: (818) 949-2634 |
| NPI Number | 1063947638 |
|---|---|
| Provider Enumeration Date | 04/20/2017 |
| Last Update Date | 07/11/2018 |
| Medicare PECOS PAC ID | 3971875691 |
|---|---|
| Medicare Enrollment ID | O20170815004351 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063947638 | NPI | - | NPPES |
| Provider Name | Marc L Eckhauser |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1811997513 PECOS PAC ID: 2567362676 Enrollment ID: I20040113000443 |
| Provider Name | Anthony C Pozun |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1275580755 PECOS PAC ID: 3779586870 Enrollment ID: I20060810000123 |
| Provider Name | Wei Jen Sheu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104069392 PECOS PAC ID: 0446306625 Enrollment ID: I20090914000750 |
| Provider Name | Mary Grace Leon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295978799 PECOS PAC ID: 8921131855 Enrollment ID: I20100729000399 |
| Provider Name | Scott M Brannan |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1033369707 PECOS PAC ID: 4688866619 Enrollment ID: I20120730000756 |
| Provider Name | Emma R Nunez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053971796 PECOS PAC ID: 5092045104 Enrollment ID: I20191002001519 |
| Provider Name | Walkennia E Simpson-earl |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861052094 PECOS PAC ID: 8325472996 Enrollment ID: I20200107002970 |
| Provider Name | Patricia Ellen Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356990774 PECOS PAC ID: 8628406691 Enrollment ID: I20200325002835 |
| Provider Name | Babafemi Pratt |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1174773873 PECOS PAC ID: 2365695509 Enrollment ID: I20201020002078 |
| Provider Name | Patrick Duffy |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1477726271 PECOS PAC ID: 2264599869 Enrollment ID: I20220330000758 |
| Provider Name | Mamdouh Khayat |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1780941583 PECOS PAC ID: 0840428108 Enrollment ID: I20221028001223 |
| Provider Name | Samuel Putnam |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1023066404 PECOS PAC ID: 5991699522 Enrollment ID: I20221129003181 |
| Provider Name | Paul Rochon |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1598913980 PECOS PAC ID: 5193910875 Enrollment ID: I20221130000799 |
| Provider Name | Alexander Shestopalov |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1053756098 PECOS PAC ID: 5698021756 Enrollment ID: I20221130001905 |
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