Individual
DR. BETHANY L. MCDANIEL-VANDERZWAAG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3421 CASSOPOLIS STREET STE 200, ELKHART, IN 46514-6774
(574) 335-8180
(574) 335-0842
Mailing address
707 CEDAR ST STE 405, SOUTH BEND, IN 46617-2059
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01048946A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1100030865
ANTHEM
IN
05
—
200147110
—
IN
Enumeration date
07/20/2005
Last updated
03/27/2024
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