Provider Demographics
NPI:1356449649
Name:MICHAEL J VENER M D P C
Entity Type:Organization
Organization Name:MICHAEL J VENER M D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:VENER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-882-2630
Mailing Address - Street 1:PO BOX 170
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-0170
Mailing Address - Country:US
Mailing Address - Phone:605-882-2630
Mailing Address - Fax:605-882-0447
Practice Address - Street 1:401 9TH AVE NW
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-1548
Practice Address - Country:US
Practice Address - Phone:605-882-2630
Practice Address - Fax:605-882-0447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN9D957VEOtherBCBS - GROUP
SDS41211Medicare PIN
SD5218640001Medicare NSC
MNC03339Medicare ID - Type UnspecifiedGROUP
MN9D957VEOtherBCBS - GROUP