Healthcare Provider Details

I. General information

NPI: 1275597650
Provider Name (Legal Business Name): WILLIAM S KAMANDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53760 GENERATIONS DR
SOUTH BEND IN
46635-1539
US

IV. Provider business mailing address

53760 GENERATIONS DR
SOUTH BEND IN
46635-1539
US

V. Phone/Fax

Practice location:
  • Phone: 574-968-4100
  • Fax: 574-968-4125
Mailing address:
  • Phone: 574-968-4100
  • Fax: 574-968-4125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number01050428A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number01050428A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: