MEDICARE: JOHN VENETOS MD LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician

General Provider Information

NPI Number	:	1568566081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN VENETOS MD LTD

Provider Business Mailing Address
First Line	:	2740 W FOSTER AVE STE 116
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3524
Country	:	US
Telephone Number	:	773-989-6262
Fax Number	:	773-989-6263

Provider Business Practice Location Address
First Line	:	2740 W FOSTER AVE STE 116
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3524
Country	:	US
Telephone Number	:	773-989-6262
Fax Number	:	773-989-6263

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN VENETOS
Credential	:
Telephone Number	:	773-989-6262

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	12/06/2016

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