1760447247 NPI number — RONALD A SCHRODT MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760447247 NPI number — RONALD A SCHRODT MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SCHRODT

Provider First Name:

RONALD

Provider Middle Name:

A

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1760447247

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/26/2016

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 776351

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

CHICAGO

Provider Business Mailing Address State Name:

IL

Provider Business Mailing Address Postal Code:

60677-6351

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

502-588-9490

Provider Business Mailing Address Fax Number:

502-272-5116

Provider First Line Business Practice Location Address:

1930 BISHOP LN

Provider Second Line Business Practice Location Address:

STE. 1600

Provider Business Practice Location Address City Name:

LOUISVILLE

Provider Business Practice Location Address State Name:

KY

Provider Business Practice Location Address Postal Code:

40218-1921

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

502-272-5044

Provider Business Practice Location Address Fax Number:

502-272-5121

Provider Enumeration Date:

04/19/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  01059452A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207R00000X , with the licence number: 35010 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 50006206 . This is a "PASSPORT / NCMA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 200346950 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
• Identifier: 041664 . This is a "SHIO / NCMA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 2867598 . This is a "CIGNA / NCMA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 000023031P . This is a "HUMANA / NMCA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 000000330959 . This is a "ANTHEM / NCMA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 64034184 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
• Identifier: 1212239 . This is a "CHA / NCMA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 2447474000 . This is a "PASSPORT ADVANTAGE / NCMA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: P00169004 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".