Provider Demographics
NPI:1114922390
Name:VANDERSLUIS, JOEL (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:VANDERSLUIS
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 1:240 W ELMWOOD DR
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4296
Mailing Address - Country:US
Mailing Address - Phone:937-224-8200
Mailing Address - Fax:937-224-1770
Practice Address - Street 1:240 W ELMWOOD DR
Practice Address - Street 2:SUITE 1000
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4296
Practice Address - Country:US
Practice Address - Phone:937-224-8200
Practice Address - Fax:937-224-1770
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-4098-V2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0894395Medicaid
F41010Medicare UPIN
OHVA0786296Medicare PIN