Provider Demographics
NPI:1275537854
Name:VAN AUKEN, HUGH J SR (CP)
Entity Type:Individual
Prefix:DR
First Name:HUGH
Middle Name:J
Last Name:VAN AUKEN
Suffix:SR
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 E DAY RD
Mailing Address - Street 2:# 160
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3463
Mailing Address - Country:US
Mailing Address - Phone:574-271-8222
Mailing Address - Fax:574-271-8896
Practice Address - Street 1:230 E DAY RD
Practice Address - Street 2:# 160
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3463
Practice Address - Country:US
Practice Address - Phone:574-271-8222
Practice Address - Fax:574-271-8896
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ20040496103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000196533OtherBLUE CROSS BLUE SHIELD
IN235300BMedicare UPIN