MEDICARE: WILLIAM VANOSDOL 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	208000000X	Pediatrics Physician	01021589A	IN

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	:	1922096734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM VANOSDOL M.D.

Provider Business Mailing Address
First Line	:	3401 E RAYMOND ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46203-4744
Country	:	US
Telephone Number	:	317-788-9769
Fax Number	:	317-781-4868

Provider Business Practice Location Address
First Line	:	2202 W MORRIS ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46221-1404
Country	:	US
Telephone Number	:	317-488-2020
Fax Number	:	317-488-2031

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	09/08/2011

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Directions to “ WILLIAM VANOSDOL M.D.” Practice Location

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