Healthcare Provider Details

I. General information

NPI: 1417934647
Provider Name (Legal Business Name): PIETER J VREEDE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N MAIN ST
RUSHVILLE IN
46173-1198
US

IV. Provider business mailing address

1300 N MAIN ST
RUSHVILLE IN
46173-1198
US

V. Phone/Fax

Practice location:
  • Phone: 765-932-7545
  • Fax: 765-932-7430
Mailing address:
  • Phone: 765-932-4111
  • Fax: 765-932-7505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01036588
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: