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General NPI Number Information
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NPI Number | 1437188091
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Entity Type | Individual
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Provider Name | PIETER J VANDERLIJN M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 11700 N MERIDIAN ST
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City | CARMEL
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State | IN
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Zip | 46032-4656
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Country | US
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Telephone | 317-688-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 1512 HIGH ST
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City | RICE LAKE
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State | WI
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Zip | 54868-1875
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Country | US
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Telephone | 715-236-2413
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 44467
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 01060551A
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License Number State | IN
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