=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891782645
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEVIN J VASKA MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2005
-----------------------------------------------------
Last Update Date | 02/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6709 S MINNESOTA AVE STE 101
-----------------------------------------------------
City | SIOUX FALLS
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57108-2593
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-274-6300
-----------------------------------------------------
Fax | 877-616-4723
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6709 S MINNESOTA AVE STE 101
-----------------------------------------------------
City | SIOUX FALLS
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57108-2593
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-274-6300
-----------------------------------------------------
Fax | 877-616-4723
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 27508-020
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 29328
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 1537
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------