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General NPI Number Information
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NPI Number | 1760304869
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Entity Type | Organization
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Legal Business Name | VITAL CARE SERVICES WI SC
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Dates
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Enumeration Date | 07/29/2026
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Last Update Date | 07/29/2026
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Provider Practice Location Address
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Address Line | 910 BEAR PAW AVE
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City | RICE LAKE
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State | WI
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Zip | 54868-1388
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Country | US
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Telephone | 212-201-1252
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Fax |
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Provider Business Mailing Address
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Address Line | 407 WILLOUGHBY AVE
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City | BROOKLYN
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State | NY
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Zip | 11205-4590
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SONIKA RANDEV
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Credential | MD
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Telephone | 617-821-5319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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