Provider Demographics
NPI:1639145840
Name:SCHOUTKO, WALTER W (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:W
Last Name:SCHOUTKO
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 1:1832 NOTTINGHAM CT
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44904-1796
Mailing Address - Country:US
Mailing Address - Phone:419-774-1600
Mailing Address - Fax:
Practice Address - Street 1:770 BALGREEN DR
Practice Address - Street 2:SUITE 207
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-4106
Practice Address - Country:US
Practice Address - Phone:419-522-6800
Practice Address - Fax:419-522-6816
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-6143207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0102936Medicaid
OHF99143Medicare UPIN
OHSC0892092Medicare ID - Type Unspecified