Provider Demographics
NPI:1851406284
Name:IDZERDA, SHEILA M (MD)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:M
Last Name:IDZERDA
Suffix:
Gender:F
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 35100
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59107-5100
Mailing Address - Country:US
Mailing Address - Phone:406-522-5437
Mailing Address - Fax:
Practice Address - Street 1:1819 S 22ND AVE
Practice Address - Street 2:STE 100
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-7070
Practice Address - Country:US
Practice Address - Phone:406-522-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9597208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT27336Medicaid
MT27336Medicaid
MT27336Medicaid
H28570Medicare UPIN