Provider Demographics
NPI:1164472841
Name:MAKLER, VYACHESLAV I (DO)
Entity type:Individual
Prefix:DR
First Name:VYACHESLAV
Middle Name:I
Last Name:MAKLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1414 E PRIMROSE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4283
Mailing Address - Country:US
Mailing Address - Phone:417-885-3888
Mailing Address - Fax:417-881-7268
Practice Address - Street 1:3801 S NATIONAL AVE STE 700
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5210
Practice Address - Country:US
Practice Address - Phone:417-885-3888
Practice Address - Fax:417-881-7216
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2025021089207T00000X
FLUO6947207T00000X
VA0102206614207T00000X
FLPA9102602363AS0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200030083Medicaid
FL292065400Medicaid
FLQ37941Medicare UPIN