Provider Demographics
NPI:1578660866
Name:VUCHETICH, JOHN P (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:VUCHETICH
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:MMC 292 UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0341
Mailing Address - Country:US
Mailing Address - Phone:612-273-8700
Mailing Address - Fax:
Practice Address - Street 1:2312 S 6TH ST
Practice Address - Street 2:SUITE F256 / 2B WEST
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1336
Practice Address - Country:US
Practice Address - Phone:612-273-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN432592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1025399OtherPREFERREDONE
MN15-61628OtherMEDICA - CHOICE
MN269324OtherFAIRVIEW
MN1100750OtherARAZ
MN140061OtherUCARE
MN93R60VUOtherBLUE CROSS BLUE SHIELD
MN15-61628OtherMEDICA - PRIMARY
MNHP31283OtherHEALTHPARTNERS
MN670023300Medicaid