Individual
DR. ROBERT R. VANDERZWAAG JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5314 LINCOLNWAY EAST, MISHAWAKA, IN 46544-4249
(574) 256-9032
(574) 256-9049
Mailing address
PO BOX 1887, ELKHART, IN 46515-1887
(574) 389-0542
(574) 522-8505
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01048973A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000109343
ANTHEM BCBS #
IN
01
—
000000692030
ANTHEM - OSCEOLA
IN
05
—
200147150A
—
IN
Enumeration date
07/20/2005
Last updated
01/27/2011
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