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General NPI Number Information
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NPI Number | 1255409017
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Entity Type | Individual
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Provider Name | MARK A VULETICH D.O.
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Gender | Male
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 03/20/2014
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Provider Practice Location Address
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Address Line | 1201 S SHANNON AVE
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City | INDIALANTIC
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State | FL
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Zip | 32903-3439
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Country | US
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Telephone | 321-213-0536
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Fax |
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Provider Business Mailing Address
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Address Line | 717 BOUNTY SQUARE DR
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City | CHARLESTON
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State | SC
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Zip | 29492-8071
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Country | US
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Telephone | 843-814-2925
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | OS8108
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | TL1401
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License Number State | SC
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