Basic Information
Provider Information
NPI: 1568550291
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VENTURA
FirstName: MICHAEL
MiddleName: S
NamePrefix: DR.
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 24 FRANK LLOYD WRIGHT DRIVE
Address2: SUITE J2000
City: ANN ARBOR
State: MI
PostalCode: 48105
CountryCode: US
TelephoneNumber: 7347476766
FaxNumber: 7342223100
Practice Location
Address1: 4200 WHITEHALL DR
Address2: SUITE 150
City: ANN ARBOR
State: MI
PostalCode: 48105
CountryCode: US
TelephoneNumber: 7349950308
FaxNumber: 2483342250
Other Information
ProviderEnumerationDate: 10/10/2006
LastUpdateDate: 06/23/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/23/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X5101011769MIY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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