Provider Demographics
NPI:1700990256
Name:SHEDD, FREDERICK G (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:G
Last Name:SHEDD
Suffix:
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 1:2325 18TH ST STE 220
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-5389
Mailing Address - Country:US
Mailing Address - Phone:812-372-2245
Mailing Address - Fax:812-375-2156
Practice Address - Street 1:2325 18TH ST STE 220
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5389
Practice Address - Country:US
Practice Address - Phone:812-372-2245
Practice Address - Fax:812-375-2156
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1039065A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100052470AMedicaid
IN180340CMedicare ID - Type Unspecified
IN100052470AMedicaid