Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 019-019623 | IL |
Y | 213EG0000X | General Practice | 019-019623 | IL |
NPI | 1003176561 |
---|---|
Provider Name | Dr. Scott Vukovich |
First Address | Buffalo Grove, IL 60089-4006 |
Second Address | Buffalo Grove, IL 60089-4006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2012 |
Last Update Date | 17/05/2012 |