Basic Information
| Provider Information | |||||||||
| NPI: | 1134165442 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VAKARELSKA | ||||||||
| FirstName: | ROSSITZA | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1950 BLUEGRASS CIR STE 250 | ||||||||
| Address2: | PO BOX 20190 | ||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820097365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076355393 | ||||||||
| FaxNumber: | 3076352199 | ||||||||
| Practice Location | |||||||||
| Address1: | 4500 W 69TH ST | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571088148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6059777000 | ||||||||
| FaxNumber: | 6059777001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 03/15/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | 4569 | SD | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services | 207R00000X | 4569 | SD | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207P00000X | 4569 | SD | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 6004006 | 05 | SD | MEDICAID | 346793700 | 05 | MN | MEDICAID | 4994203 | 01 | SD | BCBS | OTHER | 1564914 | 05 | IA | MEDICAID | 4569 | 01 | SD | DAKOTA CARE | OTHER |