Individual
THOMAS P VAN DEN DRIESSCHE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3030 LAKE AVE, SUITE32, FORT WAYNE, IN 46805-5428
(260) 424-3134
(260) 424-3138
Mailing address
3030 LAKE AVE, SUITE 32, FORT WAYNE, IN 46805-5428
(260) 424-3134
(260) 424-3138
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01028709A
IN
Other
Enumeration date
09/08/2005
Last updated
11/14/2007
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