Provider Demographics
NPI:1891782645
Name:VASKA, KEVIN J (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:J
Last Name:VASKA
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 1:6709 S MINNESOTA AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2593
Mailing Address - Country:US
Mailing Address - Phone:605-274-6300
Mailing Address - Fax:877-616-4723
Practice Address - Street 1:6709 S MINNESOTA AVE STE 101
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2593
Practice Address - Country:US
Practice Address - Phone:605-274-6300
Practice Address - Fax:877-616-4723
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27508-020207RC0000X
IA29328207RC0000X
SD1537207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA29269OtherBCBS
P00380386OtherRAILROAD MEDICARE
SD4993515OtherBCBS
MN304585400Medicaid
IA1975466Medicaid
SD6002432Medicaid
SDS101494Medicare PIN
SD4993515OtherBCBS
SDB57315Medicare UPIN