Healthcare Provider Details

I. General information

NPI: 1851852008
Provider Name (Legal Business Name): VINCENT YACCARINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14551 COUNTY ROAD 11 STE 100
BURNSVILLE MN
55337-4799
US

IV. Provider business mailing address

14551 COUNTY ROAD 11 STE 100
BURNSVILLE MN
55337-4799
US

V. Phone/Fax

Practice location:
  • Phone: 952-841-2345
  • Fax:
Mailing address:
  • Phone: 952-841-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number7893-851
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number77264
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: