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General NPI Number Information
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NPI Number | 1780869586
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Entity Type | Individual
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Provider Name | STEVEN RANDALL SHELDAHL M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/31/2007
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Last Update Date | 12/31/2007
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Provider Practice Location Address
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Address Line | G11 TASF IOWA STATE UNIVERSITY
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City | AMES
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State | IA
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Zip | 50011-3020
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Country | US
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Telephone | 515-294-2056
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Fax | 515-294-1967
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Provider Business Mailing Address
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Address Line | G11 TASF IOWA STATE UNIVERSITY
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City | AMES
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State | IA
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Zip | 50011-3020
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Country | US
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Telephone | 515-294-2056
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Fax | 515-294-1967
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 22857
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License Number State | IA
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