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1780983569

NPI Code Detail

MEDICARE: ROBERT DAVID VICHICH M.D.

MEDICARE: ROBERT DAVID VICHICH M.D.

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	208D00000X	General Practice Physician	30133	WV
2	208D00000X	General Practice Physician	84940	SC
3	208D00000X	General Practice Physician	MD472198	PA
4	207P00000X	Emergency Medicine Physician	68311	MN
5	208D00000X	General Practice Physician	20451	NV
6	208D00000X	General Practice Physician	28281	MS
7	208D00000X	General Practice Physician	13120C	WY
8	207Q00000X	Family Medicine Physician	1038	WI
9	208D00000X	General Practice Physician	DR.0065155	CO
10	207P00000X	Emergency Medicine Physician	ME146686	FL
11	208D00000X	General Practice Physician	46956	KY
12	208D00000X	General Practice Physician	12317	SD
13	208D00000X	General Practice Physician	25MA10949500	NJ

General Provider Information

NPI Number	:	1780983569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT DAVID VICHICH M.D.

Provider Business Mailing Address
First Line	:	2925 CHICAGO AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1321
Country	:	US
Telephone Number	:	612-262-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2925 CHICAGO AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1321
Country	:	US
Telephone Number	:	651-241-9700
Fax Number	:

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

Provider Enumeration Date	:	03/20/2011
Last Update Date	:	02/18/2026

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Directions to “ ROBERT DAVID VICHICH M.D.” Practice Location

Language	Start Address	Practice Location

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