Healthcare Provider Details

I. General information

NPI: 1912904798
Provider Name (Legal Business Name): JOHN NICHOLAS VENSON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 E GOLF RD STE 110
DES PLAINES IL
60016-1250
US

IV. Provider business mailing address

1455 E GOLF RD STE 110
DES PLAINES IL
60016-1250
US

V. Phone/Fax

Practice location:
  • Phone: 847-390-7666
  • Fax: 847-390-9345
Mailing address:
  • Phone: 847-390-7666
  • Fax: 847-390-9345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: