Healthcare Provider Details

I. General information

NPI: 1902979750
Provider Name (Legal Business Name): VENELIN KOUNEV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 E RAMSEY AVE
CUDAHY WI
53110-3009
US

IV. Provider business mailing address

788 N JEFFERSON ST STE 300
MILWAUKEE WI
53202-3710
US

V. Phone/Fax

Practice location:
  • Phone: 262-243-2500
  • Fax: 262-243-5395
Mailing address:
  • Phone: 414-226-4025
  • Fax: 414-274-6250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number45541
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: