Individual
DR. MICHAEL P VERCIMAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1405 E 12TH ST, SUITE 200, MENDOTA, IL 61342-1495
(815) 539-3831
(815) 538-4202
Mailing address
1405 E 12TH ST, SUITE 200, MENDOTA, IL 61342-1495
(815) 539-3831
(815) 538-4202
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036067743
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005000301
BCBS
IL
01
—
020002934
RR MEDICARE
—
05
—
036067743
—
IL
Enumeration date
12/05/2006
Last updated
12/22/2011
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