Michael J Vadovsky, PA
Individual provider Active NPI Physician Assistant · Ellsworth Afb, SD
NPI 1104337450 · NPPES record last updated Feb 5, 2019
Key facts
- NPI
- 1104337450
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- Practice address
- 2900 Doolittle Dr
Ellsworth Afb, SD 57706 - Phone
- (605) 385-3788
- NPI assigned
- Oct 13, 2017
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Physician Assistant
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Physician Assistant | 363A00000X | Yes |
Addresses
Primary practice location
2900 Doolittle Dr
Ellsworth Afb, SD 57706
Mailing address
2900 Doolittle Dr
Ellsworth Afb, SD 57706-4821
Other practice location 1
101 Bodin Cir
Fairfield, CA 94535-1809
Phone (208) 590-9773
Other providers in Ellsworth Afb, SD
- Tasha Dee Standing Soldier
- Ellen J Stevens
- Sunland Optical Co., Inc.
- Michael John-Paul Triana
- Christle Celeste Usera
- Ivan Vicente
- John Tyler Vogel
- Kayla Lynn Wede
- Brodie M Wilson
- Gavin Yseth
All providers in Ellsworth Afb, SD · Physician Assistant in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 5, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.