Provider Demographics
NPI:1285718718
Name:VENUS C PAXTON MD
Entity type:Organization
Organization Name:VENUS C PAXTON MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VENUS
Authorized Official - Middle Name:C
Authorized Official - Last Name:PAXTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-878-9700
Mailing Address - Street 1:4840 N MARINE DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-7860
Mailing Address - Country:US
Mailing Address - Phone:773-878-9700
Mailing Address - Fax:
Practice Address - Street 1:4840 N MARINE DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-7860
Practice Address - Country:US
Practice Address - Phone:773-878-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H59550Medicare UPIN
IL210252Medicare ID - Type Unspecified