Basic Information
| Provider Information | |||||||||
| NPI: | 1750965554 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMPLEX VEIN AND VASCULAR SPECIALISTS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9330 LBJ FWY STE 800 | ||||||||
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| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752434310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727925700 | ||||||||
| FaxNumber: | 2145061170 | ||||||||
| Practice Location | |||||||||
| Address1: | 12740 HILLCREST RD STE 265 | ||||||||
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| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752302086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4697802300 | ||||||||
| FaxNumber: | 4697802301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2021 | ||||||||
| LastUpdateDate: | 02/16/2022 | ||||||||
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| AuthorizedOfficialLastName: | SALHANICK | ||||||||
| AuthorizedOfficialFirstName: | MARC | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9727925700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 02/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
No ID Information.