Provider Demographics
NPI:1902252133
Name:SHEILA M IDZERDA, MD PLLC
Entity Type:Organization
Organization Name:SHEILA M IDZERDA, MD PLLC
Other - Org Name:ACORN PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:M
Authorized Official - Last Name:IDZERDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-451-9118
Mailing Address - Street 1:1819 S 22ND AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-7070
Mailing Address - Country:US
Mailing Address - Phone:406-451-9118
Mailing Address - Fax:
Practice Address - Street 1:1819 S 22ND AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-7070
Practice Address - Country:US
Practice Address - Phone:406-451-9118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9597261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care