Provider Demographics
NPI:1477584258
Name:SCHNEIDER, MARK R (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 HIGHWAY 59 S
Mailing Address - Street 2:
Mailing Address - City:THIEF RIVER FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56701-4331
Mailing Address - Country:US
Mailing Address - Phone:218-681-4747
Mailing Address - Fax:218-683-2595
Practice Address - Street 1:1720 HIGHWAY 59 S
Practice Address - Street 2:
Practice Address - City:THIEF RIVER FALLS
Practice Address - State:MN
Practice Address - Zip Code:56701-4331
Practice Address - Country:US
Practice Address - Phone:218-681-4747
Practice Address - Fax:218-683-2595
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN315632085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN539385000Medicaid
MN85D24SCOtherMNBS #
MNDA9031021972OtherPREFERRED ONE #
MNP00461967OtherMEDICARE RR
MN124769OtherUCARE #
MN1601920OtherMEDICA #
MNDA9021021972OtherPREFERRED ONE #
MN96D98SCOtherMNBS #
MN19078OtherNDBS #
MN20183OtherNDBS #
MNHP23465OtherHEALTHPARTNERS #
MN15645Medicaid
MN1600814OtherMEDICA #
MN927715OtherAMERICA'S PPO/ARAZ #
MN927715OtherAMERICA'S PPO/ARAZ #
MN300133097Medicare ID - Type UnspecifiedRR MEDICARE #
MN19078OtherNDBS #
MNDA9031021972OtherPREFERRED ONE #
MN1600814OtherMEDICA #
MND26272Medicare UPIN