MEDICARE: DR. ANITA RENEE VANDER HEYDEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	ME45975	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366431546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANITA RENEE VANDER HEYDEN MD

Provider Business Mailing Address
First Line	:	1317 MANDARIN ISLE
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33315-1648
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1317 MANDARIN ISLE
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33315-1648
Country	:	US
Telephone Number	:	954-524-7247
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	05/15/2008

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