Provider Demographics
NPI:1740397371
Name:SCHNIBBEN, KEVIN MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MARK
Last Name:SCHNIBBEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6626 E 75TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3125 S SCATTERFIELD RD STE 100
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46013-1802
Practice Address - Country:US
Practice Address - Phone:765-644-5025
Practice Address - Fax:765-643-4534
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2023-11-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01051303A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INK53445Medicare UPIN