Provider Demographics
NPI:1104826494
Name:SCHUMACHER, KRISTINA SUE (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:SUE
Last Name:SCHUMACHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 W JOHNSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-2731
Mailing Address - Country:US
Mailing Address - Phone:614-418-9988
Mailing Address - Fax:614-418-9977
Practice Address - Street 1:206 W JOHNSTOWN RD
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-2731
Practice Address - Country:US
Practice Address - Phone:614-418-9988
Practice Address - Fax:614-418-9977
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067667S207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0185820Medicaid
OHG10205Medicare UPIN
OH4227121Medicare PIN