Provider Demographics
NPI:1811987886
Name:NIKA, VASIL (MD)
Entity type:Individual
Prefix:DR
First Name:VASIL
Middle Name:
Last Name:NIKA
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 1:1511 N BLACKHAWK BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKTON
Mailing Address - State:IL
Mailing Address - Zip Code:61072-1513
Mailing Address - Country:US
Mailing Address - Phone:815-395-5879
Mailing Address - Fax:815-624-2186
Practice Address - Street 1:1511 N BLACKHAWK BLVD
Practice Address - Street 2:UNIVERSITY PRIMARY CARE CLINIC @ ROCKTON
Practice Address - City:ROCKTON
Practice Address - State:IL
Practice Address - Zip Code:61072-1513
Practice Address - Country:US
Practice Address - Phone:815-624-2644
Practice Address - Fax:815-624-2186
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105887207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036105887Medicaid
IL036105887OtherIL STATE LICENSE
IL202297Medicare ID - Type Unspecified2ND SITE PROV NUMBER FHC
IL202298Medicare ID - Type UnspecifiedPRIMARY SITE PROV NUMBER
IL036105887Medicaid