Healthcare Provider Details

I. General information

NPI: 1174505937
Provider Name (Legal Business Name): WILLIAM EARL VENANZI JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 01/14/2020
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1989 MIAMISBURG CENTERVILLE RD STE 301
CENTERVILLE OH
45459-3858
US

IV. Provider business mailing address

2912 SPRINGBORO W STE 201
MORAINE OH
45439-1674
US

V. Phone/Fax

Practice location:
  • Phone: 937-434-7353
  • Fax: 937-438-6569
Mailing address:
  • Phone: 937-297-8999
  • Fax: 937-297-4852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number35.064855
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: