Individual
SAMUEL B VANLANDINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1919 LAKE AVE, SUITE 102, PLYMOUTH, IN 46563-7830
(574) 941-2967
(574) 941-2968
Mailing address
PO BOX 6309, SOUTH BEND, IN 46660-6309
(574) 472-6700
(574) 472-6746
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01036354
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000346996
BCBS
IN
05
—
100251960
—
IN
Enumeration date
05/23/2006
Last updated
02/24/2009
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