Organization
STEPHEN J SHIDELER, M.D., P.C.
Active
Other names
Shideler Dermatology and Skin Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN SHIDELER M.D. (OWNER)
(317) 846-2396
Entity
Organization
Contact information
Practice address
755 W CARMEL DR, SUITE 101, CARMEL, IN 46032-5877
(317) 846-2396
Mailing address
755 W CARMEL DR, SUITE 101, CARMEL, IN 46032-5877
(317) 846-2396
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1025166
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DA9265
RAILROAD MEDICARE
IN
Enumeration date
04/16/2007
Last updated
06/22/2010
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