Individual
DALE DENNIS DEARDORFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
420 W 4TH ST, SUITE 180, MISHAWAKA, IN 46544-1948
(574) 247-3456
(574) 247-3455
Mailing address
PO BOX 6309, SOUTH BEND, IN 46660-6309
(574) 472-6700
(574) 472-6746
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01025330
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000214800
BCBS
IN
05
—
100220930A
—
IN
Enumeration date
05/25/2006
Last updated
02/23/2009
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