Individual
SHANMUGHAM VADIVELU
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1507 WABASH ST, SUITE 400C, MICHIGAN CITY, IN 46360-4300
(219) 871-0833
(219) 871-0836
Mailing address
1507 WABASH ST, SUITE 400C, MICHIGAN CITY, IN 46360-4300
(219) 871-0833
(219) 871-0836
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01060743A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000366517
ANTHEM BLUE SHIELD
IN
Enumeration date
07/28/2005
Last updated
07/08/2007
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