Provider Demographics
NPI:1043623069
Name:VENIS, JUAN CARLOS (MD, MPH, FAAFP)
Entity type:Individual
Prefix:DR
First Name:JUAN CARLOS
Middle Name:
Last Name:VENIS
Suffix:
Gender:M
Credentials:MD, MPH, FAAFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 N EAST ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-3425
Mailing Address - Country:US
Mailing Address - Phone:317-676-6498
Mailing Address - Fax:317-932-9404
Practice Address - Street 1:907 N EAST ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3425
Practice Address - Country:US
Practice Address - Phone:317-676-6498
Practice Address - Fax:317-932-9404
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01076457A207Q00000X, 207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300004186Medicaid