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NPI Code Detail

MEDICARE: DAVID D VANDERKIN MD

MEDICARE: DAVID D VANDERKIN 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
12085R0202XDiagnostic Radiology Physician036109875IL

Other Identifiers

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

General Provider Information

NPI Number : 1962407197
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID D VANDERKIN MD
Provider Business Mailing Address
First Line : 39798 TREASURY CTR
Second Line :
City : CHICAGO
State : IL
Zip : 60694-9700
Country : US
Telephone Number : 800-379-8731
Fax Number : 614-541-4044
Provider Business Practice Location Address
First Line : 150 W HIGH ST
Second Line :
City : MORRIS
State : IL
Zip : 60450-1463
Country : US
Telephone Number : 800-379-8731
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2005
Last Update Date : 03/24/2014

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