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General NPI Number Information
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NPI Number | 1831151869
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Entity Type | Individual
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Provider Name | SHAWN E KIDDER DO
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Gender | Male
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Dates
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Enumeration Date | 04/05/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2235 DUBOIS DRIVE NULL
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City | WARSAW
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State | IN
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Zip | 46580-3212
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Country | US
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Telephone | 574-371-2625
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Fax |
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Provider Business Mailing Address
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Address Line | 1234 E DUPONT RD SUITE 3
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City | FORT WAYNE
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State | IN
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Zip | 46825-1545
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Country | US
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Telephone | 260-373-9700
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Fax | 260-373-9740
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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 | IN02001281
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License Number State | IN
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