Provider Demographics
NPI:1992087001
Name:VLCEK, KIMBERLY ROBIN
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ROBIN
Last Name:VLCEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 N LINDBERG ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFITH
Mailing Address - State:IN
Mailing Address - Zip Code:46319-2120
Mailing Address - Country:US
Mailing Address - Phone:219-595-5384
Mailing Address - Fax:
Practice Address - Street 1:430 N LINDBERG ST
Practice Address - Street 2:
Practice Address - City:GRIFFITH
Practice Address - State:IN
Practice Address - Zip Code:46319-2120
Practice Address - Country:US
Practice Address - Phone:219-595-5384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN5370-00-4138174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist