Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 01076457A | IN |
N | 207VX0000X | Obstetrician | 01076457A | IN |
NPI | 1043623069 |
---|---|
Provider Name | Dr. Juan Carlos Venis |
First Address | Indianapolis, IN 46202-5209 |
Second Address | Indianapolis, IN 46254-1695 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2014 |
Last Update Date | 12/11/2021 |