National Provider Identifier Database

JEFFREY A DEDELOW, MD – NPI #1376758524
Diagnostic Radiology

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

Contact Information

JEFFREY A DEDELOW, MD
514 W 2ND ST
BLOOMINGTON, IN  47403-2316
Phone: 812-353-3719
Fax:
Website:
Specialty Taxonomy Code
* Diagnostic Radiology 2085R0202X
Hospice and Palliative Medicine 207RH0002X
Nuclear Radiology 2085N0904X

* Indicates primary specialty

NPI Profile & details for JEFFREY A DEDELOW

NPI Number 1376758524
Credentials MD
Entity Individual
Enumeration date 05/11/2007
Last updated 12/09/2021 - About 4 years ago
Sole proprietor1 No
Identifiers
  • IN License #: 01069197A
  • LA License #: MD026741
  • MI License #: 4301089258
  • OH License #: 35.122017
  • IN Medicaid: 201015030
  • LA Medicaid: 1049913
  • MI Medicaid: 5186380
  • MS Medicaid: 04377066
  • OH Medicaid: 0090190
  • IN Other: P01119545 RAILROAD MEDICARE
Hospital affiliation n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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