Provider Demographics
NPI:1720164973
Name:VENERABLE, RASHAWN WINFRED (DO)
Entity type:Individual
Prefix:DR
First Name:RASHAWN
Middle Name:WINFRED
Last Name:VENERABLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:850 W NORTH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-3196
Mailing Address - Country:US
Mailing Address - Phone:877-852-8463
Mailing Address - Fax:517-817-0144
Practice Address - Street 1:1801 W MAUMEE ST STE 100
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1291
Practice Address - Country:US
Practice Address - Phone:517-265-6131
Practice Address - Fax:517-265-7326
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRV015354152W00000X
MI5101015354207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4910917Medicaid
MII63903Medicare UPIN
MIOP37810001Medicare PIN