Provider Demographics
NPI:1861500258
Name:VINCES, GIACOMO VLADIMIR (DO)
Entity type:Individual
Prefix:DR
First Name:GIACOMO
Middle Name:VLADIMIR
Last Name:VINCES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 SW 160TH AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-6308
Mailing Address - Country:US
Mailing Address - Phone:954-399-4642
Mailing Address - Fax:877-859-8768
Practice Address - Street 1:3601 SW 160TH AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-6308
Practice Address - Country:US
Practice Address - Phone:954-399-4642
Practice Address - Fax:877-859-8768
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232847208600000X, 208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02731226Medicaid
NY3316H1Medicare ID - Type Unspecified
NYI18335Medicare UPIN
NY02731226Medicaid
NYG400009997Medicare PIN
NY3316H1Medicare PIN