Provider Demographics
NPI:1043788813
Name:RICHKO, VLAD (MMS, PA-C)
Entity Type:Individual
Prefix:
First Name:VLAD
Middle Name:
Last Name:RICHKO
Suffix:
Gender:M
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3724 WINTER GARDEN VINELAND RD BLDG 2
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5483
Mailing Address - Country:US
Mailing Address - Phone:877-977-7463
Mailing Address - Fax:
Practice Address - Street 1:3724 WINTER GARDEN VINELAND RD BLDG 2
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787
Practice Address - Country:US
Practice Address - Phone:407-440-2728
Practice Address - Fax:407-792-4152
Is Sole Proprietor?:No
Enumeration Date:2018-11-09
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9111786363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant