Provider Demographics
NPI:1558520007
Name:BAKANAS, JOSEPH VYTENIS (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:VYTENIS
Last Name:BAKANAS
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 1:306 ODESSA AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-1439
Mailing Address - Country:US
Mailing Address - Phone:302-898-3873
Mailing Address - Fax:
Practice Address - Street 1:2106 SILVERSIDE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4162
Practice Address - Country:US
Practice Address - Phone:302-478-8099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEE1-0000186213ES0103X
PASC005982213ES0103X
NJ25MD00303500213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery