Healthcare Provider Details

I. General information

NPI: 1831210061
Provider Name (Legal Business Name): VERONICA VENA CHERIAN P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W HARRISON STREET
CHICAGO IL
60612-3714
US

IV. Provider business mailing address

912 N OAKLEY BOULEVARD UNIT 2
CHICAGO IL
60622-4842
US

V. Phone/Fax

Practice location:
  • Phone: 773-863-7488
  • Fax: 773-869-3578
Mailing address:
  • Phone: 773-869-7488
  • Fax: 773-869-3578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: