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General NPI Number Information
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NPI Number | 1093317414
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Entity Type | Organization
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Legal Business Name | MB MEDICAL PLLC
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Dates
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Enumeration Date | 11/10/2020
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Last Update Date | 09/09/2021
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Provider Practice Location Address
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Address Line | 229 W GRAND AVE SUITE SUITE S
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City | BENSENVILLE
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State | IL
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Zip | 60106-6010
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Country | US
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Telephone | 630-235-6868
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Fax | 630-235-6868
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Provider Business Mailing Address
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Address Line | 229 W GRAND AVE STE S
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City | BENSENVILLE
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State | IL
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Zip | 60106-3365
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Country | US
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Telephone | 630-235-6868
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KRISH VENOO
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Credential | MD
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Telephone | 630-235-6868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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