Provider Demographics
NPI:1124065537
Name:VUKICH, JOHN A (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:VUKICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5715 W OLD SHAKOPEE RD # 150
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-3107
Mailing Address - Country:US
Mailing Address - Phone:608-282-2000
Mailing Address - Fax:608-282-2172
Practice Address - Street 1:10425 W NORTH AVE STE 140
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2400
Practice Address - Country:US
Practice Address - Phone:414-877-6414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30091-020207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2128OtherDEAN HEALTH INSURANCE
WI31478100Medicaid
WI180020974Medicare PIN
WI024174150Medicare PIN
WI019054340Medicare PIN
E03500Medicare UPIN
WI31478100Medicaid