Mark G Vaselakos, D.O.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

036-108833 Issued in IL

Practice address

111 E Wisconsin Ave
Milwaukee, WI 53202-4815

Phone

(414) 290-6720

Fax

(414) 290-6755

NPI assigned

Jul 19, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IL, WI2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Edgerton Hospital and Health Services Inc.

  • Critical Access Hospital
  • Edgerton, WI
  • NPI 1154350049
  Medicare reassignment NPD
• Vituity-Wisconsin Em SC

  • Emergency Medicine Physician
  • Pleasant Prairie, WI
  • NPI 1326730664
  Medicare reassignment NPD
• Osf Multi-Specialty Group

  • Internal Medicine Physician
  • Peoria, IL
  • NPI 1922445527
  Medicare reassignment NPD
• Ottawa Regional Hospital & Healthcare Center

  • General Acute Care Hospital
  • Ottawa, IL
  • NPI 1306971080
  Medicare reassignment NPD
• Emergency Medicine Specialists, S.C.

  • Emergency Medicine Physician
  • Milwaukee, WI
  • NPI 1568413524
  Medicare reassignment
• Edgerton Hospital and Health Services, Inc

  • Urgent Care Clinic/Center
  • Whitewater, WI
  • NPI 1982496295
  NPD
• Vituity-Wisconsin Em SC

  • Emergency Medicine Physician
  • Oconto Falls, WI
  • NPI 1710754296
  NPD
• Vituity-Wisconsin Em SC

  • Emergency Medicine Physician
  • Sheboygan, WI
  • NPI 1902673478
  NPD
• Central PA Pharmacy LLC.

  • Community/Retail Pharmacy
  • Patton, PA
  • NPI 1578541413
  NPD
• Ottawa Regional Hospital & Healthcare Center

  • Family Medicine Physician
  • Marseilles, IL
  • NPI 1558088203
  NPD
• Edgerton Hospital and Health Services

  • Urgent Care Clinic/Center
  • Edgerton, WI
  • NPI 1538845805
  NPD (past)
• Health Dynamics, LLC

  • Preventive Medicine/Occupational Environmental Medicine Physician
  • Milwaukee, WI
  • NPI 1255389581
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715126400000",
    "number": "1295754257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E WISCONSIN AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532024815",
            "telephone_number": "414-290-6720",
            "fax_number": "414-290-6755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E WISCONSIN AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532024815",
            "telephone_number": "414-290-6720",
            "fax_number": "414-290-6755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VASELAKOS",
        "first_name": "MARK",
        "middle_name": "G",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2024-05-08",
        "certification_date": "2024-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WI",
            "license": "53614-21",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036-108833",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036108833",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00083469",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Garbis Vartanian, M.D.
• Brintha F Vasagar, MD, MPH
• Vasco S.C.
• Kate W Vasconcellos, MD
• Vascular Laboratory Associates
• Megha Tushar Vashi, DO
• Sydnee Faith Vassallo, PA-C
• Brahm S Vasudev, MD
• Anjanette M Vaughan, PHARMD
• Dakota Vaughan, MD

• Emergency Medicine Physician in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Emergency Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.