Provider Demographics
NPI:1750498713
Name:SCHROEDER, VINITA (MD)
Entity Type:Individual
Prefix:
First Name:VINITA
Middle Name:
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4119 LOMO ALTO DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-1536
Mailing Address - Country:US
Mailing Address - Phone:214-559-0202
Mailing Address - Fax:214-559-0221
Practice Address - Street 1:4119 LOMO ALTO DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-1536
Practice Address - Country:US
Practice Address - Phone:214-559-0202
Practice Address - Fax:214-559-0221
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4504207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0013CBMedicare ID - Type Unspecified
TXG20705Medicare UPIN