MEDICARE: LAURA L VANDENHEEDE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	26282	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z1096282	OTHER	AR	STATE COMP FUND
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699749481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA L VANDENHEEDE M.D.

Provider Business Mailing Address
First Line	:	5658 HIGHWAY 260
Second Line	:	SUITE 7
City	:	LAKESIDE
State	:	AZ
Zip	:	85929-5189
Country	:	US
Telephone Number	:	928-537-3399
Fax Number	:	928-537-0475

Provider Business Practice Location Address
First Line	:	5658 HIGHWAY 260
Second Line	:	SUITE 7
City	:	LAKESIDE
State	:	AZ
Zip	:	85929-5189
Country	:	US
Telephone Number	:	928-537-3399
Fax Number	:	928-537-0475

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2006
Last Update Date	:	03/07/2023

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