Individual
HOWARD ELVINDO WIARDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 NAVARRE PL STE 5500, SOUTH BEND, IN 46601-1172
(574) 647-5200
(574) 647-5210
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
01052406
IN
2085R0203X
Therapeutic Radiology Physician
01052406
IN
2085R0204X
Vascular & Interventional Radiology Physician
Primary
01052406
IN
2085U0001X
Diagnostic Ultrasound Physician
01052406
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200261430
—
IN
01
—
M16930802
MEDICARE- BMG VEIN SPECIALISTS
IN
Enumeration date
09/13/2005
Last updated
02/12/2026
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