MEDICARE: DR. JOYCE K VACLAV DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	5101009390	MI
2	207RI0200X	Infectious Disease Physician	5101009390	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00010001	OTHER	MI	MEDICARE PTAN WAYNE COUNTY
5	P00040001	OTHER	MI	MEDICARE PTAN MONROE COUNTY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1158211544	OTHER	MI	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	00421	OTHER	MI	AETNA

General Provider Information

NPI Number	:	1588664874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOYCE K VACLAV DO

Provider Business Mailing Address
First Line	:	25803 DRESCHFIELD AVE
Second Line	:
City	:	GROSSE ILE
State	:	MI
Zip	:	48138-1602
Country	:	US
Telephone Number	:	440-934-6135
Fax Number	:	440-934-6147

Provider Business Practice Location Address
First Line	:	25803 DRESCHFIELD AVE
Second Line	:
City	:	GROSSE ILE
State	:	MI
Zip	:	48138-1602
Country	:	US
Telephone Number	:	734-692-6693
Fax Number	:	734-692-6693

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	09/30/2019

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Directions to “ DR. JOYCE K VACLAV DO” Practice Location

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