MEDICARE: JOHN VENETOS M.D.

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	036077036	IL
2	174400000X	Specialist	036077036	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952324584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN VENETOS M.D.

Provider Business Mailing Address
First Line	:	2740 W FOSTER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3500
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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	07/11/2024

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