Provider Demographics
NPI:1164473666
Name:VACEK, STEVEN J (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:VACEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 GLENWOOD ST STE 500
Mailing Address - Street 2:GLEN ROSE HEALTHCARE INC.
Mailing Address - City:GLEN ROSE
Mailing Address - State:TX
Mailing Address - Zip Code:76043-4933
Mailing Address - Country:US
Mailing Address - Phone:254-897-2202
Mailing Address - Fax:254-897-1638
Practice Address - Street 1:409 GLENWOOD ST
Practice Address - Street 2:SUITE 500
Practice Address - City:GLEN ROSE
Practice Address - State:TX
Practice Address - Zip Code:76043-4933
Practice Address - Country:US
Practice Address - Phone:254-897-2202
Practice Address - Fax:254-897-1638
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34587207Q00000X
TXQ2958207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
002000328JOtherHUMANA
WI0011368086OtherWISCONSIN MEDICARE
WI32004300Medicaid
WI32004300Medicaid
TX404689YM8GMedicare PIN