Provider Demographics
NPI:1851335442
Name:VUKELJA, SVETISLAVA JUDITH (MD)
Entity Type:Individual
Prefix:DR
First Name:SVETISLAVA
Middle Name:JUDITH
Last Name:VUKELJA
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 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:910 EAST HOUSTON STREET
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702
Practice Address - Country:US
Practice Address - Phone:903-579-9800
Practice Address - Fax:903-526-4463
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9840207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX129496904OtherCSHCN
TX129496905Medicaid
TX129496903Medicaid
TX8R1576OtherBLUE CROSS OF TEXAS
TX129496902Medicaid
TX85601FMedicare PIN
TX830003447Medicare PIN
TX8R1576OtherBLUE CROSS OF TEXAS
TX87897KMedicare PIN
TXG19024Medicare UPIN