Provider Demographics
NPI:1083691547
Name:ENDRIS, MARGARET SCHMIDT (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:SCHMIDT
Last Name:ENDRIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 MIDLAND PARK
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-9735
Mailing Address - Country:US
Mailing Address - Phone:502-633-6040
Mailing Address - Fax:502-633-6992
Practice Address - Street 1:231 MIDLAND PARK
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-9735
Practice Address - Country:US
Practice Address - Phone:502-633-6040
Practice Address - Fax:502-633-6992
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA738363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78006673Medicaid
KYP68792Medicare UPIN
KY78006673Medicaid