Provider Demographics
NPI:1013908961
Name:DENNIS, VICKIE L (MD)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:L
Last Name:DENNIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:415 JEFFERSON ST NORTH
Mailing Address - Street 2:
Mailing Address - City:WADENA
Mailing Address - State:MN
Mailing Address - Zip Code:56482-1296
Mailing Address - Country:US
Mailing Address - Phone:218-631-3510
Mailing Address - Fax:218-631-7507
Practice Address - Street 1:415 JEFFERSON ST NORTH
Practice Address - Street 2:
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-1296
Practice Address - Country:US
Practice Address - Phone:218-631-3510
Practice Address - Fax:218-631-7507
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN29545207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0702775OtherMEDICA HEALTH PLANS
254013OtherPREFERRED ONE
2114073OtherFIRST HEALTH PLAN
50A46DEOtherBLUE CROSS BLUE SHIELD
110425OtherU CARE
HP25416OtherHEALTH PARTNERS
COMPOtherONE HEALTH PLAN GREAT WES
160037460OtherRR MEDICARE
MN338577900Medicaid
COMPOtherCHAMPUS
596760OtherARAZ GROUP AMERICAS PPO
596760OtherARAZ GROUP AMERICAS PPO
0702775OtherMEDICA HEALTH PLANS