Provider Demographics
NPI:1932215506
Name:TONKOVIC-CAPIN, VISESLAV (MD)
Entity Type:Individual
Prefix:
First Name:VISESLAV
Middle Name:
Last Name:TONKOVIC-CAPIN
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 1:13284 HIGH DR
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-1667
Mailing Address - Country:US
Mailing Address - Phone:913-963-5456
Mailing Address - Fax:
Practice Address - Street 1:13284 HIGH DR
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66209-1667
Practice Address - Country:US
Practice Address - Phone:913-963-5456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-31955207N00000X, 207ND0900X
MO2009006327207ND0900X, 207N00000X
TXN8251207ND0900X, 207N00000X
CAC55335207ND0900X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN8251OtherSTATE LICENSE
KS04-31955OtherLICENSE
CAC55335OtherSTATE LICENSE
MO2009006327OtherSTATE LICENSE