Organization
DOUGLAS J VAN PUTTEN MD FACS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS J VANPUTTEN MD (PRESIDENT)
(219) 872-7546
Entity
Organization
Contact information
Practice address
8865 W 400 N, MICHIGAN CITY, IN 46360-9222
(330) 773-3544
(330) 773-3698
Mailing address
1529 MOMENTUM PL, CHICAGO, IL 60689-5315
(330) 773-3544
(330) 773-3698
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
01039408
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200922580A
—
IN
05
—
200922580B
—
IN
Enumeration date
02/26/2008
Last updated
07/15/2009
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