Basic Information
| Provider Information | |||||||||
| NPI: | 1376663526 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHIDAL | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | DUANE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 445 | ||||||||
| Address2: | |||||||||
| City: | NEW CASTLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473620445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7655211135 | ||||||||
| FaxNumber: | 7655211331 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 NO. 16TH ST. | ||||||||
| Address2: | |||||||||
| City: | NEW CASTLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473624319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7655211135 | ||||||||
| FaxNumber: | 7655211331 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2007 | ||||||||
| LastUpdateDate: | 09/10/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 01028006A | IN | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 01028006 | IN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 100383770 | 05 | IN | MEDICAID | 300073546 | 01 | RAILROAD MEDICARE | OTHER | 000000083926 | 01 | IN | ANTHEM | OTHER |