Healthcare Provider Details

I. General information

NPI: 1265761779
Provider Name (Legal Business Name): J TODD VANBUSKIRK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2009
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 WALL ST
VALPARAISO IN
46383-2512
US

IV. Provider business mailing address

601 WALL ST
VALPARAISO IN
46383-2512
US

V. Phone/Fax

Practice location:
  • Phone: 219-531-3500
  • Fax:
Mailing address:
  • Phone: 219-531-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: