Physician Compare National (NPI:1013934074)

HEALTHCARE PROVIDER: WAYNE V VIDETICH DPM

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1013934074
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1557433125
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080626000728
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	VIDETICH
	Individual professional last name
Provider First Name	WAYNE
	Individual professional first name
Provider Middle Name	V
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	WILLIAM M. SCHOLL COLLEGE OF PODIATRIC MEDICINE
	Individual professional's medical school
Graduation Year	1971
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	2710 S ST
	Group Practice or individual's line 1 address
City	LINCOLN
	Group Practice or individual's city
State	NE
	Group Practice or individual's state
Zip Code	685023252
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y