Provider Demographics
NPI:1427214071
Name:VENKATESAN, DEEN (MD)
Entity Type:Individual
Prefix:
First Name:DEEN
Middle Name:
Last Name:VENKATESAN
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 1:7513 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-4418
Mailing Address - Country:US
Mailing Address - Phone:630-631-6657
Mailing Address - Fax:630-963-2295
Practice Address - Street 1:6222 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-4610
Practice Address - Country:US
Practice Address - Phone:773-581-5000
Practice Address - Fax:773-581-5557
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098250207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine