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HOWARD ELVINDO WIARDA MD

Physicians Radiology Diagnostic Ultrasound

Provider NPI: 1801881255

Provider Information:
 HOWARD ELVINDO WIARDA MD
Gender: M
Not Sole Proprietor

Practice Location:
621 MEMORIAL DR STE 312  SOUTH BEND, IN 46601 US
Tel: 574-647-5200  Fax: --

Business Mailing Address:
2300 N EDWARD ST  DECATUR, IL 62526-4163 US
Tel: 217-876-2300  Fax: 217-876-6725

NPI Information:
NPI: 1801881255
Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N2085U0001XPhysicians
Radiology
Diagnostic Ultrasound
IN01052406
Y2085R0204XPhysicians
Radiology
IN01052406A
N2085B0100XPhysicians
Radiology
IN01052406
N2085N0700XPhysicians
Radiology
IN01052406
N2085N0904XPhysicians
Radiology
IN01052406
N2085P0229XPhysicians
Radiology
IN01052406
N2085R0202XPhysicians
Radiology
IN01052406
N2085R0203XPhysicians
Radiology
IN01052406
N2085R0204XPhysicians
Radiology
IN01052406

Other Provider Identifiers:

IssuerNumberStateType
MEDICARE- BMG VEIN SPECIALISTSM16930802IN01
MEDICARE- BMG VASCULAR INTERVENTIONAL RADIOLOGYM16930802IN01
200261430IN05



American Medical Association 2012 taxonomy code information

Code: 2085R0204X

Type:

Classification:



Definition:



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