Provider Demographics
NPI:1619110459
Name:LAURA K SCHROEDER MD PC
Entity Type:Organization
Organization Name:LAURA K SCHROEDER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SCHROEDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-368-7280
Mailing Address - Street 1:16620 N 40TH ST
Mailing Address - Street 2:STE H-4
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-3348
Mailing Address - Country:US
Mailing Address - Phone:602-368-7280
Mailing Address - Fax:602-368-7296
Practice Address - Street 1:16620 N 40TH ST
Practice Address - Street 2:STE H-4
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3399
Practice Address - Country:US
Practice Address - Phone:602-368-7280
Practice Address - Fax:602-368-7296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-09
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41709207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ424532Medicaid
AZ424532Medicaid