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NPI Code Detail

MEDICARE: DR. JOHN ANDREW SHOUDEL DPM

MEDICARE: DR. JOHN ANDREW SHOUDEL DPM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213ES0103XFoot & Ankle Surgery PodiatristIL016004443IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1760480750
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN ANDREW SHOUDEL DPM
Provider Business Mailing Address
First Line : 747 N RUTLEDGE ST
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62702-6700
Country : US
Telephone Number : 217-652-3816
Fax Number :
Provider Business Practice Location Address
First Line : 2070 W ILES AVE
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62704-4174
Country : US
Telephone Number : 217-698-6228
Fax Number : 217-698-7241
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2005
Last Update Date : 09/27/2023

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Directions to “ DR. JOHN ANDREW SHOUDEL DPM” Practice Location

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