Provider Demographics
NPI:1245238047
Name:SCHAFFER, BENJAMIN MICHAEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:MICHAEL
Last Name:SCHAFFER
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 1:1915 BISHOP LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-1901
Mailing Address - Country:US
Mailing Address - Phone:502-459-3338
Mailing Address - Fax:502-459-7509
Practice Address - Street 1:1915 BISHOP LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1901
Practice Address - Country:US
Practice Address - Phone:502-459-3338
Practice Address - Fax:502-459-7509
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY000157213E00000X, 213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4363318OtherAETNA
1054925OtherPASSPORT
KY80001571Medicaid
480025313OtherRAILROAD MEDICARE
000000051632OtherANTHEM
KY4039090001Medicare NSC
480025313OtherRAILROAD MEDICARE
4363318OtherAETNA
1054925OtherPASSPORT
611311794OtherUNITED HEALTHCARE
KY4039090001Medicare NSC
90004110OtherMEDICAID DME
KY2014601Medicare PIN
T54195Medicare UPIN
2433744000OtherPASSPORT ADVANTAGE
611311794OtherWORKERS COMP
KY8628OtherMEDICARE GROUP