Individual
BRYCE T DE VENECIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
520 S MAPLE AVE, OAK PARK, IL 60304-1022
(317) 942-7100
Mailing address
520 S MAPLE AVE, OAK PARK, IL 60304-1022
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
01086990A
IN
207P00000X
Emergency Medicine Physician
Primary
036164934
IL
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
036.164934
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/06/2020
Last updated
06/25/2024
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