Provider Demographics
NPI:1003506957
Name:SCHROEDER, GEORGE M (PA)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:M
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 N EMPORIA AVE APT 703
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-2556
Mailing Address - Country:US
Mailing Address - Phone:615-440-2526
Mailing Address - Fax:
Practice Address - Street 1:324 N EMPORIA AVE APT 703
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-2556
Practice Address - Country:US
Practice Address - Phone:615-440-2526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant