Provider Demographics
NPI:1164579017
Name:SCHNEIDER, DAVID EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:EDWARD
Last Name:SCHNEIDER
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 1:15290 PENNOCK LN
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-7163
Mailing Address - Country:US
Mailing Address - Phone:952-767-2326
Mailing Address - Fax:952-593-5187
Practice Address - Street 1:15290 PENNOCK LN
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7163
Practice Address - Country:US
Practice Address - Phone:952-767-2326
Practice Address - Fax:952-593-5187
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN28301207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN04R49SCOtherBLUE CROSS
MN1000912OtherPREFERRED ONE
MN930112648OtherMEDICARE RAILROAD
MN22254OtherAMERICA'S PPO
MN66-00615OtherMEDICA
MN618275500OtherDEPT HUMAN SERVICES
MN618275500Medicaid
MN618275500OtherMEDICAL ASSISTANCE
MN618275500OtherDEPT HUMAN SERVICES