Provider Demographics
NPI:1093841348
Name:J. MICHAEL VENTO, M.D.
Entity Type:Organization
Organization Name:J. MICHAEL VENTO, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:J. MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VENTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-460-2828
Mailing Address - Street 1:34600 CHARDON RD
Mailing Address - Street 2:BUILDING 3
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-8480
Mailing Address - Country:US
Mailing Address - Phone:440-460-2828
Mailing Address - Fax:
Practice Address - Street 1:34600 CHARDON RD
Practice Address - Street 2:BUILDING 3
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-8480
Practice Address - Country:US
Practice Address - Phone:440-460-2828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052241204C00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0643012Medicaid
OHE41907Medicare UPIN
9267541Medicare PIN
OH0643012Medicaid