Organization
THOMAS P VAN DEN DRIESSCHE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS P VAN DEN DRIESSCHE M.D. (OWNER)
(260) 424-3134
Entity
Organization
Contact information
Practice address
3030 LAKE AVE, SUITE 32, FORT WAYNE, IN 46805-5428
(260) 424-3134
(260) 424-3138
Mailing address
3030 LAKE AVE, SUITE 32, FORT WAYNE, IN 46805-5428
(260) 424-3134
(260) 424-3138
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01028709A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CK2666
RR MEDICARE GROUP
—
Enumeration date
11/14/2007
Last updated
11/14/2007
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