NPI 1033272174

Mark R Vytlacil, MD

Practitioner Anatomic Pathology & Clinical Pathology Physician Kenosha, WI

Practice location

Address: 6308 8th Ave, Kenosha, WI 53143-5031
Phone: (262) 656-2943
Fax: (262) 656-2749
Mailing address: PO Box 130, Kenosha, WI 53141-0130

Registered specialties

Anatomic Pathology & Clinical Pathology Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207ZP0102X Licence 45815 (WI)

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Registry record

NPI: 1033272174
Entity type: Individual
Sex (as registered): Male
NPI issued: 19 Dec 2006
Record last updated: 8 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.