Provider Demographics
NPI:1306843040
Name:VENTURA, SALVATORE (MD)
Entity Type:Individual
Prefix:
First Name:SALVATORE
Middle Name:
Last Name:VENTURA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W 22ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1563
Mailing Address - Country:US
Mailing Address - Phone:630-573-5000
Mailing Address - Fax:630-491-5472
Practice Address - Street 1:12200 WESTERN AVE STE 120
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-3507
Practice Address - Country:US
Practice Address - Phone:708-388-0499
Practice Address - Fax:708-388-0283
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068579207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036068579Medicaid
IL1616108OtherBCBS
IL110067424Medicare PIN
ILE12851Medicare UPIN
IL922820Medicare ID - Type UnspecifiedGROUP NUMBER
IL1616108OtherBCBS
ILC30486Medicare PIN