Provider Demographics
NPI:1063488872
Name:IHDE, JANET K (MD)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:K
Last Name:IHDE
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 2131
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92263-2131
Mailing Address - Country:US
Mailing Address - Phone:760-416-4915
Mailing Address - Fax:760-416-4916
Practice Address - Street 1:1180 N INDIAN CANYON DR STE E150
Practice Address - Street 2:SUITE 225
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4835
Practice Address - Country:US
Practice Address - Phone:760-416-4915
Practice Address - Fax:760-416-4916
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33-0871544174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG381440Medicaid
CAG381440Medicaid