Individual
DR. JAMES M VAN DAALEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
207 SPARKS AVE STE 201, JEFFERSONVILLE, IN 47130-3739
(812) 280-1419
(812) 280-1451
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
01046343A
IN
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
10146343A
IN
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
26040
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01046343A
STATE LICENSE
IN
05
—
100388990
—
IN
01
—
1059597
PASSPORT
KY
01
—
26040
STATE LICENSE
KY
05
—
64260409
—
KY
Enumeration date
08/14/2006
Last updated
02/26/2024
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