MEDICARE: JOE B VENTIMIGLIA M.D., PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	K0231	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	K0231	OTHER	TX	STATE MD LICENSE NO
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083647945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOE B VENTIMIGLIA M.D., PH.D.

Provider Business Mailing Address
First Line	:	1611 PHEASANT LN
Second Line	:
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-3436
Country	:	US
Telephone Number	:	972-983-8915
Fax Number	:	817-761-5365

Provider Business Practice Location Address
First Line	:	6350 DAVIS BLVD # 200
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-4762
Country	:	US
Telephone Number	:	972-525-9900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	01/07/2024

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