Provider Demographics
NPI:1770582371
Name:VACIK, JOSHUA (MD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:VACIK
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 1:1120 S JACKSON HWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SHEFFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35660-5777
Mailing Address - Country:US
Mailing Address - Phone:256-383-4447
Mailing Address - Fax:256-381-7999
Practice Address - Street 1:1120 S JACKSON HWY
Practice Address - Street 2:SUITE 300
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-5777
Practice Address - Country:US
Practice Address - Phone:256-383-4447
Practice Address - Fax:256-381-7999
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2015-02-27
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
AL26253207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALI09247Medicare UPIN
AL051523595Medicare PIN