Provider Demographics
NPI:1568566081
Name:JOHN VENETOS MD LTD
Entity Type:Organization
Organization Name:JOHN VENETOS MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:VENETOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-989-6262
Mailing Address - Street 1:2740 W FOSTER AVE STE 116
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3524
Mailing Address - Country:US
Mailing Address - Phone:773-989-6262
Mailing Address - Fax:773-989-6263
Practice Address - Street 1:2740 W FOSTER AVE STE 116
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3524
Practice Address - Country:US
Practice Address - Phone:773-989-6262
Practice Address - Fax:773-989-6263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE36981Medicare UPIN
IL351090Medicare ID - Type Unspecified