Individual
VANCE V VANDRAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11104 PARKVIEW CIRCLE DR, SUITE 310, FORT WAYNE, IN 46845-1672
(260) 266-5230
(260) 266-5238
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
01030783
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0511995
—
OH
05
—
100355760
—
IN
Enumeration date
06/22/2006
Last updated
10/20/2022
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