Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Vasilisa Mironovich, MD

Individual provider Family Medicine Physician · NPI 1295024479

Dr. Vasilisa Mironovich, MD is a Family Practice in Portage, Wisconsin. Qualified in 2010, 16 years ago. Practices with Divine Savior Healthcare Inc, a 132-clinician group and accepts Medicare assignment. Licensed in Wisconsin.

Years since qualifying
16
Licensed in
WI
In the registry since
2011
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

2817 New Pinery Rd
Portage, WI 53901-9240
Phone: (608) 742-4131
Fax: (608) 745-6393
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 60837-20 (WI)

Record details

NPI number1295024479
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorNo
NPI enumeratedMarch 28, 2011
Last updated in NPPESSeptember 2, 2014

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 2010 (16 years in practice)
Group practice Divine Savior Healthcare Inc — 132 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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