Healthcare Provider Details

I. General information

NPI: 1285718718
Provider Name (Legal Business Name): VENUS C PAXTON MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4840 N MARINE DR
CHICAGO IL
60640-7860
US

IV. Provider business mailing address

4840 N MARINE DR
CHICAGO IL
60640-7860
US

V. Phone/Fax

Practice location:
  • Phone: 773-878-9700
  • Fax:
Mailing address:
  • Phone: 773-878-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: VENUS C PAXTON
Title or Position: PRESIDENT
Credential: MD
Phone: 773-878-9700