| Thomas P Van Den Driessche | |
|
3030 Lake Ave Suite 32 Fort Wayne IN 46805-5428 | |
| (260) 424-3134 | |
| (260) 424-3138 |
| Full Name | Thomas P Van Den Driessche |
|---|---|
| Speciality | Family Medicine |
| Location | 3030 Lake Ave, Fort Wayne, Indiana |
| Authorized Official Name and Position | Thomas P Van Den Driessche (OWNER) |
| Authorized Official Contact | 2604243134 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Thomas P Van Den Driessche 3030 Lake Ave Suite 32 Fort Wayne IN 46805-5428 Ph: (260) 424-3134 | Thomas P Van Den Driessche 3030 Lake Ave Suite 32 Fort Wayne IN 46805-5428 Ph: (260) 424-3134 |
| NPI Number | 1538349956 |
|---|---|
| Provider Enumeration Date | 11/14/2007 |
| Last Update Date | 11/14/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538349956 | NPI | - | NPPES |
| CK2666 | Other | RR MEDICARE GROUP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 01028709A (Indiana) | Primary |
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