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Individual

LYNN VIDAKOVIC

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
2901 W KK RIVER PKWY STE 101, MILWAUKEE, WI 53215-3660
(414) 649-7708
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250

Taxonomy

Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
77097
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036114330
IL
05
100206256
WI
05
1114933660
WI
01
P00259786
RAILROAD MEDICARE NUMBER
IL
Enumeration date
08/01/2006
Last updated
01/24/2025
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