Provider Demographics
NPI:1093317414
Name:MB MEDICAL PLLC
Entity Type:Organization
Organization Name:MB MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISH
Authorized Official - Middle Name:
Authorized Official - Last Name:VENOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-235-6868
Mailing Address - Street 1:229 W GRAND AVE STE S
Mailing Address - Street 2:
Mailing Address - City:BENSENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60106-3365
Mailing Address - Country:US
Mailing Address - Phone:630-235-6868
Mailing Address - Fax:
Practice Address - Street 1:229 W GRAND AVE SUITE
Practice Address - Street 2:SUITE S
Practice Address - City:BENSENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60106-6010
Practice Address - Country:US
Practice Address - Phone:630-235-6868
Practice Address - Fax:630-235-6868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-10
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty