=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720335995
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VENTURE GASTROENTEROLOGY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2012
-----------------------------------------------------
Last Update Date | 11/08/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1117 E HALLANDALE BEACH BLVD STE 1
-----------------------------------------------------
City | HALLANDALE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33009-4488
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-933-3170
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2523 REGATTA AVE
-----------------------------------------------------
City | MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33140-4234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-654-4488
-----------------------------------------------------
Fax | 305-654-8157
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ANDREW E NULLMAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 305-534-4404
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------