Individual
PAUL JOSEPH VANDEKOPPEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2651 E DISCOVERY PKWY, BLOOMINGTON, IN 47408-9059
(812) 353-9515
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01088496A
IN
207P00000X
Emergency Medicine Physician
52464
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
524640
—
SC
Enumeration date
05/29/2018
Last updated
09/21/2022
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