Provider Demographics
NPI:1386609717
Name:VORENKAMP, THEODORE A (DPM)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:A
Last Name:VORENKAMP
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56282 KINGSMEN CT
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-7617
Mailing Address - Country:US
Mailing Address - Phone:574-255-1178
Mailing Address - Fax:
Practice Address - Street 1:425 HUEHL RD
Practice Address - Street 2:UNIT 13
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2319
Practice Address - Country:US
Practice Address - Phone:800-654-3772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2013-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000535A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100409860AMedicaid
IN100409860DMedicaid
IN000000089860OtherBC/ BS, ANTHEM
IN0005706081OtherAETNA
IN480014969OtherRAILROAD MEDICARE
IN000000089860OtherBC/ BS, ANTHEM
IN100409860AMedicaid
IN100409860DMedicaid
IN0732240001Medicare NSC
IN480014969Medicare PIN
IN480014969OtherRAILROAD MEDICARE
IN480030965Medicare PIN