Individual
DR. THOMAS R VANDERHEYDEN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
17501 GENERATIONS DR, SOUTH BEND, IN 46635-1589
(574) 234-0049
Mailing address
17501 GENERATIONS DR, SOUTH BEND, IN 46635-1589
(574) 234-0049
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
02004009A
IN
207R00000X
Internal Medicine Physician
125-050866
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000777772
ANTHEM
IN
05
—
201066120
—
IN
Enumeration date
07/10/2008
Last updated
08/28/2012
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