Provider Demographics
NPI:1063635431
Name:ELIO M VENTO MD & ASSOCIATES SC
Entity Type:Organization
Organization Name:ELIO M VENTO MD & ASSOCIATES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:B
Authorized Official - Last Name:KLIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-695-8100
Mailing Address - Street 1:2350 ROYAL BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4719
Mailing Address - Country:US
Mailing Address - Phone:847-695-8100
Mailing Address - Fax:847-695-6808
Practice Address - Street 1:2350 ROYAL BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4719
Practice Address - Country:US
Practice Address - Phone:847-695-8100
Practice Address - Fax:847-695-6808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036078120207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036078120Medicaid
IDE42251Medicare UPIN
IL587210Medicare ID - Type UnspecifiedELIO VENTO MD & ASSOC
IL036078120Medicaid