Provider Demographics
NPI:1275536302
Name:SCHUTZMAN, JEROME B (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:B
Last Name:SCHUTZMAN
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:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-331-0774
Mailing Address - Fax:859-578-3800
Practice Address - Street 1:711 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017
Practice Address - Country:US
Practice Address - Phone:859-287-3045
Practice Address - Fax:859-578-3800
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01070934A207RC0000X, 207RI0011X
KY30303207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64303035Medicaid
KY50024717Medicaid
OH0885225Medicaid
KYP00920126OtherRAILROAD MEDICARE
IN100463880Medicaid
KY50024717Medicaid
INM400070496Medicare PIN
KYP00920126OtherRAILROAD MEDICARE
OH0885225Medicaid
0551805Medicare PIN
KY00954012Medicare PIN