Healthcare Provider Details

I. General information

NPI: 1891637146
Provider Name (Legal Business Name): SATVIK VENKATESH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 MAIN ST STE C
PEORIA IL
61602-1080
US

IV. Provider business mailing address

815 MAIN ST STE A
PEORIA IL
61602-1080
US

V. Phone/Fax

Practice location:
  • Phone: 309-672-4977
  • Fax:
Mailing address:
  • Phone: 309-672-4977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125.088387
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: