Provider Demographics
NPI:1790728178
Name:VENINCASA, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:VENINCASA
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 1:500 LA VIDA CT
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-6565
Mailing Address - Country:US
Mailing Address - Phone:214-356-3594
Mailing Address - Fax:
Practice Address - Street 1:500 LA VIDA CT
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-6565
Practice Address - Country:US
Practice Address - Phone:972-449-0540
Practice Address - Fax:972-449-0550
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3614207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX060026137OtherRAILROAD MEDICARE
TX047038701Medicaid
TX88K981OtherBCBS
F80889Medicare UPIN
TX88K981Medicare ID - Type Unspecified