=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992938898
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELANIE MONROE VENABLE M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2009
-----------------------------------------------------
Last Update Date | 03/27/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 E WASHINGTON ST SUITE 301
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60602-2152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-252-9500
-----------------------------------------------------
Fax | 312-337-9243
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50 E WASHINGTON ST SUITE 301
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60602-2152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-252-9500
-----------------------------------------------------
Fax | 312-337-9243
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 036128707
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------