Provider Demographics
NPI:1396744611
Name:VUKOV, ALLEN M (MD)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:M
Last Name:VUKOV
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 1:8940 N WOODSAGE ROAD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615
Mailing Address - Country:US
Mailing Address - Phone:309-243-3541
Mailing Address - Fax:309-243-3224
Practice Address - Street 1:8940 N WOODSAGE ROAD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615
Practice Address - Country:US
Practice Address - Phone:309-243-3541
Practice Address - Fax:309-243-3224
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-079284207RH0003X
IL036084589207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E18421Medicare UPIN
ILL04071Medicare ID - Type Unspecified