Individual
CHARLES RAYMOND SHIDEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., PH.D.
Contact information
Practice address
640 JACKSON ST, SAINT PAUL, MN 55101-2502
(651) 254-2039
(651) 254-9333
Mailing address
7401 METRO BLVD STE 210, EDINA, MN 55439-3086
(952) 920-4915
(952) 915-6098
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
54992
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1841466026
NPI
MN
Enumeration date
05/07/2008
Last updated
10/03/2017
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