Basic Information
| Provider Information | |||||||||
| NPI: | 1740710482 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHROEDER | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | PAUL | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 MEMORIAL SQ STE 50 | ||||||||
| Address2: | |||||||||
| City: | GREENFIELD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461401357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3174686257 | ||||||||
| FaxNumber: | 3174686268 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 E BOYD AVE STE 120 | ||||||||
| Address2: | |||||||||
| City: | GREENFIELD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461402832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3174623441 | ||||||||
| FaxNumber: | 3174776316 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2017 | ||||||||
| LastUpdateDate: | 08/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5101023445 | IN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 11020824A | IN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 02006495A | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.