Provider Demographics
NPI:1124029681
Name:VILSACK, DAVID RAY (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RAY
Last Name:VILSACK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 S AIKEN AVE
Mailing Address - Street 2:STE 108
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1521
Mailing Address - Country:US
Mailing Address - Phone:412-621-5700
Mailing Address - Fax:412-621-2890
Practice Address - Street 1:532 S AIKEN AVE
Practice Address - Street 2:STE 108
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1521
Practice Address - Country:US
Practice Address - Phone:412-621-5700
Practice Address - Fax:412-621-2890
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001542L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0004292912OtherAETNA
PA1503489OtherGATEWAY
PA887857OtherBS
PA40683OtherHEALTH AMERICA
PA65298OtherMEDPLUS
PA202304OtherUPMC
PA480020822OtherRAILROAD MEDICARE
PA0005031350012Medicaid
PA887857OtherBS
PA202304OtherUPMC