Provider Demographics
NPI:1073505533
Name:SCHROEDER, KEVIN RAYMOND (DPM)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:RAYMOND
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ROSEMAR CIR
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-1263
Mailing Address - Country:US
Mailing Address - Phone:304-485-8824
Mailing Address - Fax:
Practice Address - Street 1:3 ROSEMAR CIR
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-1263
Practice Address - Country:US
Practice Address - Phone:304-485-8824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002509213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0752690Medicaid
WV1073505533Medicaid
WVWV4781AMedicare PIN
WV1073505533Medicaid
OHP01497424Medicare PIN
OHH254740Medicare PIN