Individual
DR. THOMAS R. VIDIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
303 S NAPPANEE ST, ELKHART, IN 46514-2066
(574) 296-3282
(574) 296-3324
Mailing address
PO BOX 2968, ELKHART, IN 46515-2968
(574) 296-3282
(574) 296-3324
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
01033614A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100112810A
—
IN
Enumeration date
06/15/2005
Last updated
12/19/2012
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