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Individual

ESTER P J VAN DER WAL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
121 S SAINT LOUIS BLVD, SOUTH BEND, IN 46617-2924
(574) 233-3123
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01053280
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000374875
ANTHEM BCBS
IN
05
200522070
IN
01
P00742719
RAILROAD MEDICARE
IN
Enumeration date
06/06/2006
Last updated
02/19/2021
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