Organization
DELAINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS J VAN PUTTEN MD (OWNER/CEO)
(219) 464-7546
Entity
Organization
Contact information
Practice address
1620 COUNTRY CLUB RD, SUITE C, VALPARAISO, IN 46383-2251
(219) 464-7546
(866) 467-3763
Mailing address
1620 COUNTRY CLUB RD, SUITE C, VALPARAISO, IN 46383-2251
(219) 464-7546
(866) 467-3763
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
01039408A
IN
208200000X
Plastic Surgery Physician
01039408A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000917194
ANTHEM
IN
05
—
201275700A, B, C
—
IN
Enumeration date
01/15/2015
Last updated
03/25/2015
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