Provider Demographics
NPI:1235106089
Name:VORPERIAN, VICKEN R (MD)
Entity type:Individual
Prefix:
First Name:VICKEN
Middle Name:R
Last Name:VORPERIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 AMERICAN AVE SUITE 410
Mailing Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES CARDIOLOGY
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-5071
Mailing Address - Country:US
Mailing Address - Phone:262-928-8300
Mailing Address - Fax:262-521-1482
Practice Address - Street 1:725 AMERICAN AVE SUITE 410
Practice Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES CARDIOLOGY
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5071
Practice Address - Country:US
Practice Address - Phone:262-928-8300
Practice Address - Fax:262-521-1482
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI34682207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31942600Medicaid
WI000068144Medicare PIN
WI31942600Medicaid
68375Medicare PIN