MEDICARE: SAMUEL B VANLANDINGHAM M.D.

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	208600000X	Surgery Physician	01036354	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000346996	OTHER	IN	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871548438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL B VANLANDINGHAM M.D.

Provider Business Mailing Address
First Line	:	PO BOX 6309
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46660-6309
Country	:	US
Telephone Number	:	574-472-6700
Fax Number	:	574-472-6746

Provider Business Practice Location Address
First Line	:	1919 LAKE AVE
Second Line	:	SUITE 102
City	:	PLYMOUTH
State	:	IN
Zip	:	46563-7830
Country	:	US
Telephone Number	:	574-941-2967
Fax Number	:	574-941-2968

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	02/24/2009

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