Individual
SANJAY VASUDEVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
600 EAST BLVD, ELKHART, IN 46514-2483
(574) 523-3161
Mailing address
4755 AMERITECH DR, SOUTH BEND, IN 46628-9120
(574) 271-2558
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01044609A
IN
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
01044609
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000082213
ANTHEM
IN
05
—
103221444
—
MI
01
—
110114090
RAIL ROAD MEDICARE
IN
05
—
200082090
—
IN
Enumeration date
03/07/2006
Last updated
10/17/2017
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