Healthcare Provider Details

I. General information

NPI: 1235191487
Provider Name (Legal Business Name): JOHN MICHAEL VENER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W CHANDLER ST
ARLINGTON MN
55307-2127
US

IV. Provider business mailing address

200 4TH AVE NE
ARLINGTON MN
55307-9641
US

V. Phone/Fax

Practice location:
  • Phone: 507-964-2271
  • Fax: 507-964-8490
Mailing address:
  • Phone: 507-964-2761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16638
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: