Provider Demographics
NPI:1154320893
Name:SCHILT, BRUCE F (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:F
Last Name:SCHILT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17525 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-8528
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17525 RIVER RD
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46062-8528
Practice Address - Country:US
Practice Address - Phone:317-773-7711
Practice Address - Fax:317-776-6561
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027238A207RI0011X, 207RC0000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100319300AMedicaid
INC24365Medicare UPIN
IN100319300AMedicaid
IN312150Medicare ID - Type UnspecifiedMEDICARE NUMBER
IN898190N9Medicare PIN