Healthcare Provider Details

I. General information

NPI: 1295783082
Provider Name (Legal Business Name): DAVID E VANREKEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 12/31/2021
Certification Date: 12/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 N SHERMAN DR
INDIANAPOLIS IN
46226-4462
US

IV. Provider business mailing address

8910 PURDUE RD STE 500
INDIANAPOLIS IN
46268-3161
US

V. Phone/Fax

Practice location:
  • Phone: 317-541-3400
  • Fax: 317-541-3444
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01035126A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: