Healthcare Provider Details

I. General information

NPI: 1275579781
Provider Name (Legal Business Name): DONNA RUSSELL VENTURINI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 12/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7376 BUSINESS CENTER DR
AVON IN
46123-8662
US

IV. Provider business mailing address

7376 BUSINESS CENTER DR
AVON IN
46123-8662
US

V. Phone/Fax

Practice location:
  • Phone: 317-272-7887
  • Fax: 317-272-7888
Mailing address:
  • Phone: 317-272-7887
  • Fax: 317-272-7888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01047145A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: