Dedelow, Jeffrey Alan
Dedelow, Jeffrey Alan is an individual health care provider with primary practice located at 514 W 2Nd St , Bloomington IN 47403-2316. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Hospice and Palliative Medicine, Allopathic & Osteopathic Physicians / Nuclear Radiology, Allopathic & Osteopathic Physicians / Diagnostic Radiology. Allopathic & Osteopathic Physicians / Diagnostic Radiology is his primary health care specialty. Dedelow, Jeffrey Alan can be contacted via phone (812) 353-3719.Contact Information
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Hospice and Palliative Medicine | 207RH0002X | 01069197A | Indiana |
| Allopathic & Osteopathic Physicians / Nuclear Radiology | 2085N0904X | 4301089258 | Michigan |
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | MD026741 | Louisiana |
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 4301089258 | Michigan |
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 35.122017 | Ohio |
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 01069197A | Indiana |
Profile Details
| NPI number | 1376758524 |
|---|---|
| LBN Legal business name | Dedelow, Jeffrey Alan |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 11th, 2007 |
| Last updated | Dec 9th, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1376758524 | NPPES |
| Louisiana | MEDICAID | 1049913 | |
| Louisiana | MEDICAID | 04377066 | |
| Louisiana | MEDICAID | 201015030 | |
| Louisiana | Other | P01119545 | |
| Louisiana | MEDICAID | 5186380 | |
| Louisiana | MEDICAID | 0090190 |
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