MEDICARE: DR. JOHN NORMAN VRTISKA MD

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	207VG0400X	Gynecology Physician	T01174	KS

Other Identifiers

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

General Provider Information

NPI Number	:	1720159072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN NORMAN VRTISKA MD

Provider Business Mailing Address
First Line	:	112 ROSS BLVD
Second Line	:	SUITE A
City	:	DODGE CITY
State	:	KS
Zip	:	67801-7219
Country	:	US
Telephone Number	:	620-225-5496
Fax Number	:	620-225-5495

Provider Business Practice Location Address
First Line	:	112 ROSS BLVD
Second Line	:	SUITE A
City	:	DODGE CITY
State	:	KS
Zip	:	67801-7219
Country	:	US
Telephone Number	:	620-225-5496
Fax Number	:	620-225-5495

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	07/08/2007

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