Provider Demographics
NPI:1083710099
Name:SCHLICHTER, MARK HOWARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:HOWARD
Last Name:SCHLICHTER
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 1:7412 ROCKVILLE RD
Mailing Address - Street 2:STE. A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-3097
Mailing Address - Country:US
Mailing Address - Phone:317-271-0041
Mailing Address - Fax:317-271-0148
Practice Address - Street 1:7412 ROCKVILLE RD
Practice Address - Street 2:STE. A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-3097
Practice Address - Country:US
Practice Address - Phone:317-271-0041
Practice Address - Fax:317-271-0148
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000358A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100058410AMedicaid
IN0419390001Medicare NSC
IN100058410AMedicaid
INT34506Medicare UPIN