Provider Demographics
NPI:1649839911
Name:VANDECAPPELLE, MADELINE (MD)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:VANDECAPPELLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 W US HIGHWAY 20
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:IN
Mailing Address - Zip Code:46540-9713
Mailing Address - Country:US
Mailing Address - Phone:574-825-8068
Mailing Address - Fax:574-825-4873
Practice Address - Street 1:226 W US HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:IN
Practice Address - Zip Code:46540-9713
Practice Address - Country:US
Practice Address - Phone:574-825-8068
Practice Address - Fax:574-825-4873
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01086638A207Q00000X
IN11020655A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine