Organization Name: | ROGER A. SCHROEDER MD SC |
NPI Number: | 1013394279 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ROGER A. SCHROEDER (OWNER) |
Mailing Address: | 727 9th St Carrollton |
State: | IL US |
Postal Code: | 620161427 |
Phone Number: | 2179426006 |
Fax Number: | 2179426008 |
NPI Enumeration Date: | 04/27/2015 |
NPI Last Update Date: | 05/05/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 036065715 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |