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NPI Code Detail

MEDICARE: SAMANTHA VENKATESH

MEDICARE: SAMANTHA VENKATESH
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
1207N00000XDermatology Physician036159751IL

General Provider Information

NPI Number : 1417417825
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA VENKATESH
Provider Business Mailing Address
First Line : 539 N DEARBORN ST
Second Line :
City : CHICAGO
State : IL
Zip : 60654-4812
Country : US
Telephone Number : 312-549-4400
Fax Number :
Provider Business Practice Location Address
First Line : 539 N DEARBORN ST
Second Line :
City : CHICAGO
State : IL
Zip : 60654-4812
Country : US
Telephone Number : 312-549-4400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2019
Last Update Date : 10/01/2024

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Directions to “ SAMANTHA VENKATESH ” Practice Location

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