Individual
JOHN H. VANDERGRIFT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
600 EAST BLVD, ELKHART, IN 46514-2483
(574) 523-3161
(574) 273-1137
Mailing address
4755 AMERITECH DR, SOUTH BEND, IN 46628-9120
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
01036755
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100259060
—
IN
05
—
8460412
—
WA
Enumeration date
03/08/2006
Last updated
06/12/2008
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