Provider Demographics
NPI:1033192554
Name:VLCKO, VLADIMIR J (DO)
Entity Type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:J
Last Name:VLCKO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 N. PRESTWICK WAY
Mailing Address - Street 2:LECANTO, FL. 34461
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461-6916
Mailing Address - Country:US
Mailing Address - Phone:352-220-1218
Mailing Address - Fax:352-249-4494
Practice Address - Street 1:2860 N. PRESTWICK WAY
Practice Address - Street 2:LECANTO, FL. 34461
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461
Practice Address - Country:US
Practice Address - Phone:352-220-1218
Practice Address - Fax:352-249-4494
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS3896207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00021833OtherMEDICARE RR
FL82206OtherBCBS OF FL
FLCJ7430OtherMEDICARE RR GROUP
FLOS3896OtherSTATE LICENSE NUMBER
FL77940OtherBCBS FL GRP
FL82206OtherBCBS OF FL
FLCJ7430OtherMEDICARE RR GROUP
FL10723317OtherCAQH
FL038784300Medicaid
FL77940AOtherMEDICARE GROUP ID
FL77940OtherBCBS FL GRP
FL038784300Medicaid