MEDICARE: WALTER M. VUKCEVICH, A MEDICAL GROUP, INC.

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	174400000X	Specialist

General Provider Information

NPI Number	:	1811172257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALTER M. VUKCEVICH, A MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	2572 ATLANTIC AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-2751
Country	:	US
Telephone Number	:	562-424-0931
Fax Number	:	562-595-4030

Provider Business Practice Location Address
First Line	:	2572 ATLANTIC AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-2751
Country	:	US
Telephone Number	:	562-424-0931
Fax Number	:	562-595-4030

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	DR. WALTER M. VUKCEVICH
Credential	:	M.D.
Telephone Number	:	562-424-0931

Provider Enumeration Date	:	01/04/2008
Last Update Date	:	01/04/2008

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