IndividualActive
Michael De Venecia, PA-C
NPI 1457046351 · Physician Assistant · Rantoul, IL
Provider details
- NPI number
- 1457046351
- Entity type
- Individual
- Primary specialty
- Physician AssistantPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
- Medical Physician Assistant363AM0700X
Physician Assistants & Advanced Practice Nursing Providers
Practice location
841 Broadmeadow Rd
Rantoul, IL 61866-2166
Phone: (217) 282-3010
Approximate (ZIP-level) locationGet directions
Mailing address
508 Yalow Dr
Champaign, IL 61822-1140
Registry dates
- Enumerated
- 2023-04-06
- Last updated
- 2023-04-06
- Certified
- 2023-02-16
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.