Basic Information
| Provider Information | |||||||||
| NPI: | 1497905202 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENDE | ||||||||
| FirstName: | VAMSHI | ||||||||
| MiddleName: | KIRAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 781076 | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482781076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175284800 | ||||||||
| FaxNumber: | 3178651479 | ||||||||
| Practice Location | |||||||||
| Address1: | 3500 FRANCISCAN WAY | ||||||||
| Address2: | |||||||||
| City: | MICHIGAN CITY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463600021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2198798511 | ||||||||
| FaxNumber: | 2199332288 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2008 | ||||||||
| LastUpdateDate: | 02/14/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 01078207A | IA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 036-137716 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | 036-137716 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 208M00000X | 01078207A | IN | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 1497905202 | 01 | LA | NPI | OTHER |