Provider Demographics
NPI:1689620809
Name:SCHROEDER, KEVIN S (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:S
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:804 40TH STREET WEST
Mailing Address - Street 2:C/O STOUTAMYER STRATOS SCHROEDER WHALEY RIZZO & ASSO MD
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205
Mailing Address - Country:US
Mailing Address - Phone:941-749-5464
Mailing Address - Fax:941-747-1815
Practice Address - Street 1:2020 59TH STREET WEST
Practice Address - Street 2:BLAKE MEDICAL CENTER
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209
Practice Address - Country:US
Practice Address - Phone:941-792-6611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00563562085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL300013482OtherRAIL ROAD MEDICARE
FL061651600Medicaid
FL08905Medicare PIN
FL061651600Medicaid
FLE22654Medicare UPIN