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NPI Code Detail

MEDICARE: SALLY J VAHOVICK PA-C

MEDICARE: SALLY J VAHOVICK PA-C
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
1363A00000XPhysician Assistant2508-23WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1700110947
Entity Type Code : Individual
Provider Name (Legal Business Name) : SALLY J VAHOVICK PA-C
Provider Business Mailing Address
First Line : 8444 N 90TH ST STE 100
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85258-4437
Country : US
Telephone Number : 602-248-8886
Fax Number :
Provider Business Practice Location Address
First Line : 2970 S CHASE AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53207-6407
Country : US
Telephone Number : 414-934-6400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2009
Last Update Date : 12/17/2025

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