Individual
DANDRAE DOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
401 N SAWYER RD, KENDALLVILLE, IN 46755-2568
(260) 347-8610
(260) 347-8617
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
01028388A
IN
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
Primary
01028388
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000082078
ANTHEM BC/BS
IN
05
—
100322930A
—
IN
01
—
1235
PHP
IN
Enumeration date
07/21/2005
Last updated
10/11/2022
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