Provider Demographics
NPI:1255332813
Name:SCHROEDER, REID M (MD)
Entity Type:Individual
Prefix:DR
First Name:REID
Middle Name:M
Last Name:SCHROEDER
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 1:615 VALLEY VIEW DR
Mailing Address - Street 2:STE 202
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6150
Mailing Address - Country:US
Mailing Address - Phone:309-762-1072
Mailing Address - Fax:309-762-1094
Practice Address - Street 1:615 VALLEY VIEW DR
Practice Address - Street 2:STE 202
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6150
Practice Address - Country:US
Practice Address - Phone:309-762-1072
Practice Address - Fax:309-762-1094
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA319952085R0202X
WI63896-202085R0202X
IL036-0867342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILR03888Medicare PIN
IAI0851Medicare PIN
G03474Medicare UPIN
ILL59220Medicare PIN
ILL59220Medicare PIN