Individual
MS. CLAUDETTE R DANDRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6920 INDIANAPOLIS BLVD, HAMMOND, IN 46324-2206
(219) 763-8112
(219) 764-3251
Mailing address
PO BOX 1430, PORTAGE, IN 46368-9230
(219) 763-8112
(219) 764-3251
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
01036379
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000096837
ANTHEM PROVIDER ID NO
IN
05
—
100215560
—
IN
Enumeration date
08/15/2006
Last updated
11/25/2020
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