Basic Information
| Provider Information | |||||||||
| NPI: | 1194223800 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VANDYKE MD OB/GYN PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9161 NARCOOSSEE RD STE B209 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328275764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073160156 | ||||||||
| FaxNumber: | 4073169997 | ||||||||
| Practice Location | |||||||||
| Address1: | 9161 NARCOOSSEE RD STE B209 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328275764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073160156 | ||||||||
| FaxNumber: | 4073169997 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2018 | ||||||||
| LastUpdateDate: | 01/28/2018 | ||||||||
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| AuthorizedOfficialLastName: | ARIZA | ||||||||
| AuthorizedOfficialFirstName: | TRACEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 4073160156 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
No ID Information.