Provider Demographics
NPI:1174517775
Name:VLOKA, MARGOT E (MD)
Entity type:Individual
Prefix:
First Name:MARGOT
Middle Name:E
Last Name:VLOKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-367-8188
Mailing Address - Fax:208-367-7063
Practice Address - Street 1:6140 W CURTISIAN AVE
Practice Address - Street 2:STE 100
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704
Practice Address - Country:US
Practice Address - Phone:208-367-8188
Practice Address - Fax:208-367-7063
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200186207RC0000X, 207RC0001X
WI51118207RC0000X, 207RC0001X
IDM12718207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY725981Medicare ID - Type Unspecified
NY01860168Medicaid
NYG69270Medicare UPIN