Provider Demographics
NPI:1154504538
Name:GAGOVIC, VERONIKA (MD)
Entity Type:Individual
Prefix:
First Name:VERONIKA
Middle Name:
Last Name:GAGOVIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 WESTWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401
Mailing Address - Country:US
Mailing Address - Phone:715-847-2558
Mailing Address - Fax:715-847-2557
Practice Address - Street 1:411 WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4152
Practice Address - Country:US
Practice Address - Phone:715-847-2558
Practice Address - Fax:715-847-2557
Is Sole Proprietor?:No
Enumeration Date:2007-12-09
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01064558A207R00000X
WI52813-20207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200914860Medicaid
WI1154504538Medicaid
WI392650017Medicare UPIN
IN165460D4Medicare PIN
WI1154504538Medicaid