Provider Demographics
NPI:1578674180
Name:VANDERLINDEN, CHAD D (MD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:D
Last Name:VANDERLINDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHAD
Other - Middle Name:D
Other - Last Name:VANDERLINDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2701 17TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-5351
Mailing Address - Country:US
Mailing Address - Phone:309-563-2054
Mailing Address - Fax:
Practice Address - Street 1:2701 17TH ST
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201
Practice Address - Country:US
Practice Address - Phone:309-563-2054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-115492207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
28518OtherBC WELLMARK
IAP00376745OtherRR MEDICARE
98838OtherBC WELLMARK
ILP00379017OtherRR MEDICARE
98935OtherBC WELLMARK
ILP00379017OtherRR MEDICARE
I40241Medicare UPIN
98935OtherBC WELLMARK