MEDICARE: JOYCE K VACLAV DO PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	5101009390	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	DD5444	OTHER	MI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00421	OTHER	MI	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1158211544	OTHER	MI	BCBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	440H203220	OTHER	MI	BCBS GROUP
8	E77788	OTHER	MI	HAP

General Provider Information

NPI Number	:	1538101720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOYCE K VACLAV DO PC

Provider Business Mailing Address
First Line	:	25803 DRESCHFIELD AVE
Second Line	:
City	:	GROSSE ILE
State	:	MI
Zip	:	48138-1602
Country	:	US
Telephone Number	:	440-934-6135
Fax Number	:	440-934-6147

Provider Business Practice Location Address
First Line	:	25803 DRESCHFIELD AVE
Second Line	:
City	:	GROSSE ILE
State	:	MI
Zip	:	48138-1602
Country	:	US
Telephone Number	:	440-934-6135
Fax Number	:	440-934-6147

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. JOYCE K VACLAV
Credential	:	DO
Telephone Number	:	734-558-8891

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	01/27/2021

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