Provider Demographics
NPI:1992971717
Name:VENICE ORTHOPAEDICS, P.A.
Entity type:Organization
Organization Name:VENICE ORTHOPAEDICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:VIDOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-497-1771
Mailing Address - Street 1:836 SUNSET LAKE BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-7554
Mailing Address - Country:US
Mailing Address - Phone:941-497-1771
Mailing Address - Fax:941-497-1860
Practice Address - Street 1:836 SUNSET LAKE BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-7554
Practice Address - Country:US
Practice Address - Phone:941-497-1771
Practice Address - Fax:941-497-1860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty