Provider Demographics
NPI:1548265622
Name:DEPAUW, ARTHUR PHILIP (MD)
Entity type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:PHILIP
Last Name:DEPAUW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 UNIVERSITY COMMONS
Mailing Address - Street 2:STE 230
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1571
Mailing Address - Country:US
Mailing Address - Phone:574-234-4100
Mailing Address - Fax:574-282-1739
Practice Address - Street 1:6301 UNIVERSITY COMMONS
Practice Address - Street 2:STE 350
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1571
Practice Address - Country:US
Practice Address - Phone:574-234-4100
Practice Address - Fax:574-282-1739
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030166208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN264180XOtherMEDICARE PTAN
000000086165OtherANTHEM
IN200014180Medicaid
IN264180XOtherMEDICARE PTAN