Provider Demographics
NPI:1689603557
Name:PAXTON, VENUS (MD)
Entity Type:Individual
Prefix:
First Name:VENUS
Middle Name:
Last Name:PAXTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4840 N MARINE DR
Mailing Address - Street 2:C/O CHGO LAKESHORE HOSPITAL
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-7860
Mailing Address - Country:US
Mailing Address - Phone:773-878-9700
Mailing Address - Fax:773-907-4607
Practice Address - Street 1:4840 N MARINE DR
Practice Address - Street 2:C/O CHGO LAKESHORE HOSPITAL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-7860
Practice Address - Country:US
Practice Address - Phone:773-878-9700
Practice Address - Fax:773-907-4607
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH59550Medicare UPIN
IL210252Medicare ID - Type Unspecified