Organization
DEMOTTE PHYSICIANS INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID VANDER LUGT M.D. (PRESIDENT)
(219) 987-3581
Entity
Organization
Contact information
Practice address
520 8TH AVE NE, DEMOTTE, IN 46310-9108
(219) 987-3581
(219) 987-7137
Mailing address
PO BOX 20, DEMOTTE, IN 46310-0020
(219) 987-3581
(219) 987-7137
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000082478
BLUE CROSS/BLUE SHIELD
IN
05
—
200489280A
—
IN
Enumeration date
06/19/2006
Last updated
11/16/2007
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