Basic Information
| Provider Information | |||||||||
| NPI: | 1790713923 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHRODE | ||||||||
| FirstName: | MARC | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 36100 EUCLID AVE | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | WILLOUGHBY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440944456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4409518360 | ||||||||
| FaxNumber: | 4409519408 | ||||||||
| Practice Location | |||||||||
| Address1: | 36100 EUCLID AVE | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | WILLOUGHBY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440944456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4409518360 | ||||||||
| FaxNumber: | 4409519408 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 03/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 34004757 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0011X | 34004757 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RC0000X | 34004757 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 0782461 | 05 | OH | MEDICAID | 100650 | 01 | OH | KAISER | OTHER | 2500801 | 01 | OH | UNITED HEALTHCARE | OTHER | 000000132619 | 01 | OH | ANTHEM BLUE CROSS/BLUE SH | OTHER | 4326064 | 01 | OH | AETNA | OTHER | 341487428 | 01 | OH | TAX ID | OTHER | 060030888 | 01 | OH | RAILROAD MEDICARE | OTHER | 51701 | 01 | OH | QUALCHOICE | OTHER |