Provider Demographics
NPI:1316033822
Name:SHRADER, BETSY SUSAN (DO)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:SUSAN
Last Name:SHRADER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:SUSAN
Other - Last Name:SHRADER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:901 MACARTHUR BOULEVARD
Mailing Address - Street 2:ANESTHESIA DEPARTMENT
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2901
Mailing Address - Country:US
Mailing Address - Phone:219-836-7040
Mailing Address - Fax:219-513-1127
Practice Address - Street 1:901 MACARTHUR BOULEVARD
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3901
Practice Address - Country:US
Practice Address - Phone:219-836-1600
Practice Address - Fax:219-513-1127
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003018A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000393566OtherANTHEM BCBS
F79253Medicare UPIN
IN000000393566OtherANTHEM BCBS