# THOMAS P VAN DEN DRIESSCHE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538349956
- **Authorized official:** DR. THOMAS P VAN DEN DRIESSCHE M.D. (OWNER)
- **Authorized official phone:** (260) 424-3134

## Contact information

- **Practice address:** 3030 LAKE AVE, SUITE 32, FORT WAYNE, IN 46805-5428
- **Practice address phone:** (260) 424-3134
- **Practice address fax:** (260) 424-3138
- **Mailing address:** 3030 LAKE AVE, SUITE 32, FORT WAYNE, IN 46805-5428
- **Mailing address phone:** (260) 424-3134
- **Mailing address fax:** (260) 424-3138

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 01028709A | IN | Yes |

## Other

- **Enumeration date:** 11/14/2007
- **Last updated:** 11/14/2007