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NPI Code Detail

MEDICARE: DIVYA VENKAT

MEDICARE: DIVYA VENKAT
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
1207R00000XInternal Medicine Physician036161090IL

General Provider Information

NPI Number : 1750944831
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIVYA VENKAT
Provider Business Mailing Address
First Line : 539 N DEARBORN ST
Second Line :
City : CHICAGO
State : IL
Zip : 60654-4812
Country : US
Telephone Number : 312-549-4400
Fax Number :
Provider Business Practice Location Address
First Line : 539 N DEARBORN ST
Second Line :
City : CHICAGO
State : IL
Zip : 60654-4812
Country : US
Telephone Number : 312-549-4400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2019
Last Update Date : 09/22/2022

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Directions to “ DIVYA VENKAT ” Practice Location

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