Individual
JEFFREY ALAN DEDELOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
514 W 2ND ST, BLOOMINGTON, IN 47403-2316
(812) 353-3719
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
01069197A
IN
2085N0904X
Nuclear Radiology Physician
4301089258
MI
2085R0202X
Diagnostic Radiology Physician
Primary
01069197A
IN
2085R0202X
Diagnostic Radiology Physician
35.122017
OH
2085R0202X
Diagnostic Radiology Physician
4301089258
MI
2085R0202X
Diagnostic Radiology Physician
MD026741
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0090190
—
OH
05
—
04377066
—
MS
05
—
1049913
—
LA
05
—
201015030
—
IN
05
—
5186380
—
MI
01
—
P01119545
RAILROAD MEDICARE
IN
Enumeration date
05/11/2007
Last updated
12/09/2021
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