Provider Demographics
NPI:1760447247
Name:SCHRODT, RONALD A (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:A
Last Name:SCHRODT
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:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:1930 BISHOP LN
Practice Address - Street 2:STE. 1600
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1921
Practice Address - Country:US
Practice Address - Phone:502-272-5044
Practice Address - Fax:502-272-5121
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059452A207R00000X
KY35010207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50006206OtherPASSPORT / NCMA
IN200346950Medicaid
KY041664OtherSHIO / NCMA
KY2867598OtherCIGNA / NCMA
KY000023031POtherHUMANA / NMCA
KY000000330959OtherANTHEM / NCMA
KY64034184Medicaid
KY1212239OtherCHA / NCMA
KY2447474000OtherPASSPORT ADVANTAGE / NCMA
KYP00169004OtherRAILROAD MEDICARE
KY000000330959OtherANTHEM / NCMA
KY000023031POtherHUMANA / NMCA
KY50006206OtherPASSPORT / NCMA