Healthcare Provider Details

I. General information

NPI: 1093841348
Provider Name (Legal Business Name): J. MICHAEL VENTO, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34600 CHARDON RD BUILDING 3
WILLOUGHBY OH
44094-8480
US

IV. Provider business mailing address

34600 CHARDON RD BUILDING 3
WILLOUGHBY OH
44094-8480
US

V. Phone/Fax

Practice location:
  • Phone: 440-460-2828
  • Fax:
Mailing address:
  • Phone: 440-460-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number35052241
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35052241
License Number StateOH

VIII. Authorized Official

Name: DR. J. MICHAEL VENTO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 440-460-2828