Provider Demographics
NPI:1457397796
Name:VUCKOVIC, STEVAN (DO)
Entity Type:Individual
Prefix:
First Name:STEVAN
Middle Name:
Last Name:VUCKOVIC
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 SIERRA DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7241
Mailing Address - Country:US
Mailing Address - Phone:317-528-4284
Mailing Address - Fax:317-865-8355
Practice Address - Street 1:1201 S MAIN ST
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-8481
Practice Address - Country:US
Practice Address - Phone:219-757-6310
Practice Address - Fax:219-757-6312
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001492A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200048610Medicaid
IN000000722411OtherANTHEM TRADITIONAL
IN200048610Medicaid
INM400061712Medicare PIN
IN138200LMedicare ID - Type Unspecified