Provider Demographics
NPI:1578766952
Name:RAYKOVA, VANIA (MD)
Entity Type:Individual
Prefix:
First Name:VANIA
Middle Name:
Last Name:RAYKOVA
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:PO BOX 779
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48764-0779
Mailing Address - Country:US
Mailing Address - Phone:989-362-9411
Mailing Address - Fax:989-362-9925
Practice Address - Street 1:116 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:HALE
Practice Address - State:MI
Practice Address - Zip Code:48739-9272
Practice Address - Country:US
Practice Address - Phone:989-728-4211
Practice Address - Fax:989-728-4334
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC54998207Q00000X
MI4301084171207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700E012740OtherBCBSM GROUP NUMBER
MI1235131137OtherBCBSM - BLH
MI1578766952Medicaid
MI700E012740OtherBCBSM GROUP NUMBER
MI0N40170Medicare PIN