Individual
JONATHAN VIDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
615 N MICHIGAN ST 1ST FL HOSPITALIST STE, SOUTH BEND, IN 46601-1033
(574) 647-3050
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01079813A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300015885
—
IN
Enumeration date
04/22/2015
Last updated
05/01/2023
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