Individual
SHAWN E KIDDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2235 DUBOIS DRIVE, NULL, WARSAW, IN 46580-3212
(574) 371-2625
Mailing address
1234 E DUPONT RD, SUITE 3, FORT WAYNE, IN 46825-1545
(260) 373-9700
(260) 373-9740
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
IN02001281
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000634019
ANTHEM
IN
01
—
000000664741
ANTHEM
IN
05
—
200089430
—
IN
Enumeration date
04/05/2006
Last updated
03/07/2023
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