Individual
VINCENT GIANNI VACKETTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
6000 N ALLEN RD, PEORIA, IL 61614-3294
(309) 691-1400
Mailing address
6000 N ALLEN RD, PEORIA, IL 61614-3294
(309) 691-1400
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
016006029
IL
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
016006029
IL
213E00000X
Podiatrist
016006029
IL
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
016006029
IL
Other
Enumeration date
05/22/2018
Last updated
12/26/2024
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