JEFFREY ALAN DEDELOW M.D. - NPI 1376758524 - Radiology in Bloomington, IN

Q: What is Jeffrey Dedelow's NPI number?

The NPI number for Jeffrey Dedelow is 1376758524. It was assigned to this individual provider in the NPPES registry on May 11, 2007.

Q: What is Jeffrey Dedelow's specialty?

The primary specialty registered for this NPI is Radiology, specializing in Diagnostic Radiology, with taxonomy code 2085R0202X.

Q: When was this NPI record last updated?

The NPPES record for Jeffrey Dedelow was last updated on December 9, 2021. NPI Profile syncs with the weekly NPPES data releases published by CMS.

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About Jeffrey Alan Dedelow M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JEFFREY ALAN DEDELOW M.D. (NPI 1376758524) is an individual diagnostic radiology provider in Bloomington, Indiana, licensed in Indiana (01069197A) and active in the NPI registry since May 2007. He maintains a secondary practice location in Bloomington.

NPPES Registry Identity

NPI1376758524

Entity TypeIndividualMale

Primary Taxonomy2085R0202X

Provider Legal NameJEFFREY ALAN DEDELOWCredential: M.D.

Location Address514 W 2ND STBloomington, IN 47403-2316

Mailing Address250 N Shadeland AveIndianapolis, IN 46219-4959

Phone(812) 353-3719

Sole ProprietorNo

Enumeration DateMay 11, 2007

Last NPPES UpdateDecember 9, 20214 updates tracked since enumeration

NPPES CertifiedDecember 9, 2021

✔ NPI 1376758524 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyRadiology · Diagnostic RadiologyAllopathic & Osteopathic Physicians

Taxonomy Code2085R0202X

Licenses✔ Licensed in IN · 01069197A✔ Licensed in LA · MD026741✔ Licensed in MI · 4301089258✔ Licensed in OH · 35.122017

Definition

A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

Also ListedInternal Medicine · Hospice and Palliative MedicineTaxonomy 207RH0002X · License 01069197A (IN)

Also ListedRadiology · Nuclear RadiologyTaxonomy 2085N0904X · License 4301089258 (MI)

514 W 2ND ST, Bloomington, IN 47403

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Secondary Practice Location 1

Location 1429 S Landmark AveBloomington, IN 47403-5003 · Phone (812) 332-8242 · Fax (812) 332-7684

Other Identifiers 6

Medicaid04377066MS

Medicaid201015030IN

OtherP01119545IN · Railroad Medicare

Medicaid1049913LA

Medicaid5186380MI

Medicaid0090190OH

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. ROBERT STONE MD

Emergency Medicine (Hospice and Palliative Medicine)