Healthcare Provider Details

I. General information

NPI: 1760304869
Provider Name (Legal Business Name): VITAL CARE SERVICES WI SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 BEAR PAW AVE
RICE LAKE WI
54868-1388
US

IV. Provider business mailing address

407 WILLOUGHBY AVE
BROOKLYN NY
11205-4590
US

V. Phone/Fax

Practice location:
  • Phone: 212-201-1252
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SONIKA RANDEV
Title or Position: OWNER
Credential: MD
Phone: 617-821-5319