Provider Demographics
NPI:1376663526
Name:SHIDAL, WILLIAM DUANE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DUANE
Last Name:SHIDAL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 445
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-0445
Mailing Address - Country:US
Mailing Address - Phone:765-521-1135
Mailing Address - Fax:765-521-1331
Practice Address - Street 1:1000 NO. 16TH ST.
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-4319
Practice Address - Country:US
Practice Address - Phone:765-521-1135
Practice Address - Fax:765-521-1331
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01028006A2085R0202X
IN010280062085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100383770Medicaid
300073546OtherRAILROAD MEDICARE
IN000000083926OtherANTHEM
300073546OtherRAILROAD MEDICARE
IN000000083926OtherANTHEM