Provider Demographics
NPI:1558430371
Name:SCHROEDER, GREG M (MD)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:M
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2813 S SAINT FRANCIS LN
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-4673
Mailing Address - Country:US
Mailing Address - Phone:605-336-0572
Mailing Address - Fax:605-335-3505
Practice Address - Street 1:1100 E 26TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-4023
Practice Address - Country:US
Practice Address - Phone:605-338-7098
Practice Address - Fax:605-335-3505
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD1434207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5700520Medicaid
SD0001894OtherBLUE SHIELD
MN4F388SCOtherBLUE SHIELD
IA952390Medicaid
MN4F388SCOtherBLUE SHIELD
SDS1894Medicare PIN