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General NPI Number Information
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NPI Number | 1760141055
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Entity Type | Organization
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Legal Business Name | VENETIAN WELLNESS CLINIC INC
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Dates
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Enumeration Date | 12/14/2021
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Last Update Date | 01/13/2022
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Provider Practice Location Address
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Address Line | 1101 TAMIAMI TRL S STE 108
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City | VENICE
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State | FL
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Zip | 34285-4133
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Country | US
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Telephone | 941-488-2332
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Fax |
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Provider Business Mailing Address
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Address Line | 529 SHETLAND CIR
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City | NOKOMIS
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State | FL
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Zip | 34275-1628
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Country | US
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Telephone | 605-920-0260
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAMELA MILLER
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Credential | DO
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Telephone | 605-920-0508
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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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