Provider Demographics
NPI:1720159072
Name:VRTISKA, JOHN NORMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:NORMAN
Last Name:VRTISKA
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 1:112 ROSS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-7219
Mailing Address - Country:US
Mailing Address - Phone:620-225-5496
Mailing Address - Fax:620-225-5495
Practice Address - Street 1:112 ROSS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-7219
Practice Address - Country:US
Practice Address - Phone:620-225-5496
Practice Address - Fax:620-225-5495
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST01174207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ299380Medicaid
KSPENDINGMedicaid
AZD00517Medicare UPIN
AZ22012Medicare ID - Type Unspecified
KSPENDINGMedicaid