Individual
MICHAEL DE VENECIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
841 BROADMEADOW RD, RANTOUL, IL 61866-2166
(217) 282-3010
Mailing address
508 YALOW DR, CHAMPAIGN, IL 61822-1140
(618) 843-1021
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085009622
IL
363AM0700X
Medical Physician Assistant
—
—
Other
Enumeration date
04/06/2023
Last updated
04/06/2023
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